[Physiotherapy in rehabilitation of patients with degenerative disk diseases from positions of evidence-based medicine: a literature review]. / Fizioterapiya v reabilitatsii bol'nykh s degenerativnymi zabolevaniyami pozvonochnika s pozitsii dokazatel'noi meditsiny: obzor literatury.

Back pain is one of the most urgent problems of rehabilitation. Patients with this pathology have a leading place among neurological patients in terms of the number of days of disability. The high economic costs in society are explained by the need for lumbar surgery (discectomy, spinal fusion and disc prosthesis) and rehabilitation after it. The effectiveness of rehabilitative measures is determined both by the patient's rehabilitative potential and by the choice of rehabilitative methods. OBJECTIVE: To evaluate the effectiveness of physiotherapy in patients with degenerative disk diseases from positions of evidence-based medicine according to the scientific and technical literature. MATERIAL AND METHODS: The analysis of scientific and technical literature sources and the study of materials of meta-analyses, systematic reviews (depth of search was 20 years) on the evaluation of effectiveness of physiotherapeutical methods in the rehabilitation of patients with degenerative disk diseases have been conducted. RESULTS: The ability of pulsed magnetic field to reduce the intensity of pain and improve the functional capacities of the spine in patients with low back pain has been identified. There was a pronounced analgesic end-point of low-level laser therapy in acute and chronic back pain at short and medium-term (up to 12 months) observation, as well as the ability of the method to reduce temporary disability in degenerative disk diseases. CONCLUSION: The use of magnetotherapy and low-level laser therapy can be recommended for the treatment of patients with degenerative disk diseases (C grade of recommendations, 3rd level of evidence). The recommendation is based on the results of 10 RCTs (1.111 patients with degenerative disk diseases), 3 meta-analyses, 1 systematic review and 1 Cochrane review (a total of 3.431 patients).

[Functional and activity limitations in patients after a stroke]. / Funktsional'nye ogranicheniya i ogranicheniya aktivnosti u bol'nykh posle insul'ta.

One of the main characteristics of the goal of rehabilitation after a stroke is the focus on restoring a certain level of functioning. The formation of the goal of rehabilitation and the implementation of effective rehabilitation are possible when taking into account not only the clinical diagnosis, but also the problems and possibilities of the patient in the categories of the International Classification of Functioning, Disabilities and Health (ICF). PURPOSE OF THE STUDY: To assess the types and degree of functional limitations and activity limitations in patients after ischemic and hemorrhagic strokes in the early recovery period, taking into account the type of stroke and the affected vascular pool. MATERIAL AND METHODS: 528 patients after a stroke were examined. Functional limitations and activity limitations were assessed in ICF categories, taking into account the type of stroke (hemorrhagic, ischemic) and the affected vascular system (carotid, vertebrobasilar), including dysfunctions (motor, global and specific mental functions, balance function, functions of the cardiovascular system), activity restrictions (limitations of paretic limbs mobility, functional independence from others). To quantify the degree of limitation, generally accepted rating scales were used (Medical Research Council Scale, Modified Ashworth Scale of muscle spasticity, Frenchay arm test, Hauser ambulation index, Rivermead mobility index, Functional Independence Measure, «Memory for images¼, «Learning 10 words¼, «Red-black Schulte-Platonov tables¼, Luscher color test, The hospital Anxiety and Depression Scale, Recovery Locus of Control), stabilography method, registration of office and outpatient blood pressure. RESULTS: Limitations of the functions of paretic limbs and activity associated with maintaining body position, walking, movement, transfer, manipulation of objects and self-care, dependence on others in everyday life were found in most patients after hemorrhagic stroke (in 94-95%) and ischemic (in 88-93%) stroke in the carotid pool, while more severe disorders were recorded in cases of hemorrhagic type of stroke. Violation of global mental functions was recorded in » of patients, specific mental functions - in 60-75% of patients after hemorrhagic stroke and ischemic stroke in the carotid pool. In ischemic stroke happens in the vertebrobasilar basin, the limitations of the daily activity of patients were determined by the violation of static and dynamic balance; a mild degree of impairment of specific mental functions and limitation of activity (self-service) were also recorded. CONCLUSION: After a stroke, motor function disorders, mobility limitations of paretic limbs and self-service, postural disorders are recorded. After an ischemic stroke in the vertebrobasilar basin, the restrictions on the activity of patients are determined by postural disorders. Taking into account the identified features of functional limitations and activity limitations in patients after a stroke will allow developing a differentiated approach not only to the formation of goals and objectives of rehabilitation, but also to the choice of rehabilitation methods.

[Therapeutic effects of mirror therapy in patients after stroke]. / Terapevticheskie effekty zerkal'noi terapii u bol'nykh posle insul'ta.

Impaired function of the upper extremity after a stroke is a common cause of persistent disability and decreased social activity. Mirror therapy is an effective method for correcting hand function after a stroke. This method triggers neuroplasticity and can accelerate the recovery of functions after a wide range of neurological disorders. OBJECTIVE: To evaluate the effect of mirror therapy on the regression of motor disorders in the paretic arm, functional and psychological disorders, the patient's functioning and quality of life, risk factors for recurrent stroke in the early recovery period of stroke. MATERIAL AND METHODS: We examined 219 patients after stroke, including 154 patients after ischemic stroke (IS) and 65 patients after hemorrhagic stroke (HS) in the early recovery period (21 days to 6 months). All patients received a standard medical rehabilitation course including medications, physical rehabilitation, and physiotherapeutic treatment. Patients were divided into four groups depending on the stroke type and the medical rehabilitation course received: two study treatment groups (post-IS and post-HS groups), which consisted of patients receiving the standard medical rehabilitation course and mirror therapy, and two comparison groups (post-IS and post-HS), in which patients received only the standard medical rehabilitation course. All patients before and after the medical rehabilitation course were evaluated for neurological disorders (NIHSS, Ashworth scale of muscle spasticity, Medical Research Council (MRC) Scale and handgrip test), functional limitations (Frenchay Arm Test, Hauser Ambulation Index, Rivermead Mobility Index, Functional Independence Measure (FIM), ICF), mental status («Visual Memory¼ and «10 Word Memory¼ methods, Schulte-Platonoff tables, Lüscher color test, Hospital Anxiety and Depression Scale (HADS), Locus of Control Recovery Questionnaire), quality of life (EQ-5D), arterial hypertension (Arterial Hypertension in Adults. Clinical Guidelines, 2020). RESULTS: Addition of the mirror therapy to the standard course provided additional therapeutic effects: in patients with IS, the high tone of the paretic muscles of the arm significantly decreased (by 46%); the target blood pressure was achieved in 96% of patients; severe disorders of functional independence and depression regressed; significant changes of mental functions parameters (visual memory, shifting attention); improvement of activity and participation parameters (carrying in the hands, self-care, housekeeping). In patients with HS, the muscle strength of the paretic arm significantly increased (by 35%); the target blood pressure was achieved in all patients; improvement of mental functions (motivation, shifting attention, visual memory), activity and participation parameters (objects moving and manipulation, self-care), and decreased level of depression were observed. CONCLUSION: The addition of mirror therapy to the standard of care for patients after stroke resulted in regression of neurological deficit, motor disorders in the paretic arm, improvement of emotions and motivation, mitigation of recurrent stroke risk factors, as well as significant impact on the cognitive functions and enhancement of patients' capabilities of self-care.

[The integral estimation of health problems and effectiveness of stage rehabilitation in patients after ischemic stroke]. / Integral'naia otsenka narushenii zdorov'ia i éffektivnosti étapnoi reabilitatsii bol'nykh posle ishemicheskogo insul'ta.

The multidisciplinary assessment of health problems after stroke should take into account not only motor, speech disorders, disability, but also postural balance, type and level of mental disorders, degree of working hand dysfunctions, cortical motor neuron functional indicators, and risk factors for recurrent stroke. OBJECTIVE: To develop a methodology for the integrated assessment of health problems and the effectiveness of stage rehabilitation in patients after ischemic stroke (IS) and risk factors for recurrent stroke. MATERIAL AND METHODS: Examinations were made in 101 patients (mean age 59.78±8.63 years) after IS in the middle cerebral arterial bed in the early recovery period. Of them, 62 patients were examined in the early and late recovery periods of stroke. The investigators assessed neurological disorders using National Institutes of Health Stroke Scale (NIHSS), Ashworth Spasticity Scale, dysarthria scale, Medical Research Council Scale and wrist dynamometry, Frenchay Arm Test), Self-Care Rating Scale (Barthel index) and social and living activities (Rehabilitation Activities Profile Scale), psychological status (procedures of Memory for Pictures and Ten Words, Schulte-Platonov Tables, Luscher Color Test, Hospital Anxiety and Depression Scale (HADS), Recovery Locus of Control Scale) questionnaire, functional (stabilography, transcranial magnetic stimulation) and laboratory (lipid profile test) results. The integrated assessment of health problems was defined as the sum of ranks of the signs studied; the effectiveness of stage rehabilitation in patients was defined as the coefficient of the dynamics of the sum of ranks of informative indicator. RESULTS: There was a preponderance of moderate motor impairments; the high incidence of cognitive impairment and paretic hand dysfunctions; a change in the temporal parameters of the nerve impulse through the corticospinal tract; obvious balance dysfunctions; and the relationship between equilibrium and the visual analyzer. The integral indicator of the level of health correlated with clinical and functional findings. After the rehabilitation, severe arm/hand paresis was not detected; paretic arm/hand function improved; the number of patients with moderate paresis declined; impaired vital and social activities reduced significantly; the proportion of patients with low dependence on others was as much as 86%; balance and psychological functions improved; the mean blood pressure reached the target values. An integrated effectiveness evaluation showed that 33, 58, and 9% of patients were discharged with a significant improvement, improvement, and a slight improvement, respectively. CONCLUSION: The integrated approach to evaluating health problems and the effectiveness of rehabilitation makes it possible to comprehensively estimate (taking into account neurological, psychological, functional disorders, risk factors for recurrent stroke) the harm to a patient's health and activity, which is associated with prior stroke and its reversal due to rehabilitation.

[The specific features of the clinical, functional and psychological status of the patients during the early and late restorative periods of ischemic stroke]. / Osobennosti kliniko-funktsional'nogo i psikhologicheskogo statusov patsientov v rannem i pozdnem vosstanovitel'nykh periodakh ishemicheskogo insul'ta.

BACKGROUND: When choosing the algorithm of rehabilitative measures, the localization of the stroke, brain reserve, and neuroplasticity as well as clinical characteristics (motor, postural, speech, cognitive impairments), etc. are taken into consideration. Monitoring the health status of the patients is an integral component of and an important condition for the successful post-stroke rehabilitation. AIM: The objective of the present study was to evaluate the clinical, functional and psychological status of the patients with stroke during the early and late restorative periods. MATERIAL AND METHODS: The neurological disorders were characterized based on the National Institutes of Health Stroke Scale (NIHSS), the results of hand-grip dynamometry, the Frenchay arm test, and the modified Ashworth scale of muscle spasticity in the combination with the data on the activity of everyday life and the psychological status of the patients. Sstabilograpy, encephalography, and diagnostic transcranial magnetic stimulation (TMS) were carried out. The level of health of the patients was evaluated as the integral measure representing the sum of scores of ranked characters. RESULTS: A total of 106 patients who had undergone ischemic stroke were available for the examination. During the early post-stroke period the gross disturbances of attention and vertical stabilization were documented. In addition, the dependence of equilibrium on the function of visual analyzer was revealed together with the large number of correlations between the clinical-psychological indicators and the functional parameters associated with neurological deficiency and disability. In the late rehabilitation period, the improvement of attention, the enhanced capability for maintaining equilibrium, and the positive influence of visual memory on the degree of dependence on the assistance of other persons were apparent in the majority of the patients even though some of them exhibited the signs of severe depression. CONCLUSION: Taking account of the aforementioned clinical, functional and psychological characteristics of the patients surviving ischemic provides a basis for the differential approach to the correction of the complex of rehabilitative measures.

[The comprehensive step-by-step rehabilitation of the patients after acute disturbances of the cerebral circulation]. / Kompleksnaia étapnaia reabilitatsiia bol'nykh posle ostrogo narusheniia mozgovogo krovoobrashcheniia.

AIM: The objective of the present study was to evaluate the therapeutic effectiveness of the comprehensive one- and two-stage rehabilitation including the application of mirror therapy and orthetics on an individual basis. MATERIAL AND METHODS: The study included 125 patients (66 men and 59 women) at the medium age of 57 (52; 63) years who had undergone the acute disorders of cerebral circulation (the diagnosis was verified based on the results of CT or MRI of the brain). The localization of stroke in the basin of the left middle cerebral artery was documented in 41,1% of the patients and in the basin of the right middle cerebral artery in 58,9% of them. The severity of neurologic deficit was estimated with use of the Stolyarova scale, Ashfort spastic scale, the Timed Walking Test with pegs and nine holes, the Bartel index of the activities of the daily life. Also estimated were the severity of anxiety and depressive disorders (based on the Spilberger and Beck scales). The state of the cognitive functions was evaluated by means of the mini-mental state examination (MMSE) and the Clock Drawing Test). The Medical Outcomes Study Short Form-36 (scores of MOS SF-36) was employed to estimate the quality of life of the patients. The rehabilitation of the patients was conducted either in 1 or 2 stages, i.e. during the early and (or) late post-treatment periods. In the early period, the medicamental treatment, therapeutic physical exercises, paraffinic and ozoceritic applications, hand massage, electrostimulation of the antagonists of the spastic muscles as well as mirror therapy were used. The rehabilitative process during the late post-treatment period was completed using orthetics of the affected (paretic) hand on an individual basis. RESULTS: The two-stage medical rehabilitation exercised during the early post-treatment period after the stroke with the application of mirror therapy promoted the decrease of the degree of paresis in the affected hands from 2.50 (1.68; 3.19) to 1,12 (0.81; 1.75) scores (p<0,001) and the increase of the motor activity of the affected extremities (the volume of movements, walking skills, the ability to fulfil biomechanical tests). The program of the comprehensive rehabilitation based on the use of orthetics of the paretic hand on an individual basis made it possible to achieve the maximum lowering of muscle hypertonia in the hand affected by paresis (to less than 0.50 scores, i.e. by 0.625 scores) [0.06; 0.75] (p<0.05). The maximum efficiency (83%) was achieved by means of two-stage rehabilitation. CONCLUSION: The comprehensive two-stage medical rehabilitation of the patients who had undergone the acute disorder of cerebral circulation with use of mirror therapy in the combination with orthetics on an individual basis produces the high therapeutic effect, with the effectiveness of the treatment amounting to 83% and the considerable positive dynamics of motor functions documented in 59% of the patients.

Millimeter waves in the treatment of neurological manifestations of vertebral osteochondrosis.

A new millimeter-wave therapeutic technique, which combines pulsed electromagnetic radiation with noise, was developed. This technique produces analgesic and trophic effects, and it also produces an effect on the functional activity of electrically excitable regions of nerve fibers. It can therefore be employed for treating affected nerves and muscles. Hence, it may broaden the range of optimal combinations of biotropic parameters of millimeter-wave methods used in neurological practice.