[Healthy and harmonic childhood - foundation of the «Health of healthy¼ concept]. / Zdorovoe i garmonichnoe detstvo ­ fundament kontseptsii «Zdorov'e zdorovykh¼.

Within the framework of the «Health of Healthy¼ concept (A.N. Razumov) a medical, psychological and pedagogical «Sonatal-pedagogy¼ system (M.L. Lazarev) aimed at harmonizing the mental and physical development of children from the prenatal age has been developed In Russia. The system has been tested since 1983 on population of more than 70 thous. children. The results showed its high effectiveness and safety (in relation to pregnancy, childbirth, breastfeeding, somatic health, psychomotor development and children's abilities). Scaling of the Sonatal-pedagogy, in particular the system of prenatal education, will contribute to the sanitation of the Russian gene pool, demography improvement and formation of responsible parenthood.

[On the Draft Regulations on Districts of Sanitary (Mountain Sanitary) Protection of Natural Medicinal Resources: Comments, Suggestions]. / O proekte Polozheniya ob okrugakh sanitarnoi (gorno-sanitarnoi) okhrany prirodnykh lechebnykh resursov: zamechaniya, predlozheniya.

The purpose of the article is to attract the attention of specialists in the resort business in the document being developed - the Decree of the Government of the Russian Federation «On Approval of the Regulations on the Districts of Sanitary (Mining and Sanitary) Protection of Natural Medicinal Resources¼, the draft of which is proposed for discussion. The article presents all the comments on the discussed draft Regulation and proposals for making appropriate changes with their reasoned justification. The proposals put forward to change the wording of specific paragraphs of the Regulation are aimed at protecting and preserving the wealth of our country - natural healing factors that form the basis of sanatorium treatment. The proposals made to edit the paragraphs of the Regulation will undoubtedly guarantee the preservation of Russia's natural healing resources in order to use them for the prevention, treatment and rehabilitation of the population of our country and the successful development of the resort industry.

[Predictors of upper limbs' function in patients with cervical tetraplegia]. / Prediktory funktsii verkhnei konechnosti u patsientov s tservikal'noi tetraplegiei.

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 «balance¼). 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: ASIAarm - 100, functional tenodesis (FT) - 91, ML - 73, SI - 18; the classification tree had one branching at the ASIAarm point of 17.3 score. The rank significance for the threshold of 40 scores was: ASIAarm - 100, ML - 59, SI - 50, FT - 28, M response from the median nerve - 5; the classification tree had one branching at the ASIAarm 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 (ASIAarm) 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.

[A word about V.S. Ulashchik (on the 80th anniversary of his birth)]. / Slovo o V.S. Ulashchike (k 80-letiyu so dnya rozhdeniya).

In the history of physiotherapy there are many outstanding names, one of which is the name of Acad. V.S. Ulashchik's name is one of them. The medical community knows V.S. Ulashchik as an outstanding scientist in the field of physiotherapy, regenerative and integrative medicine, organizer of health care, who made a huge contribution to the development, first of all, of national physiotherapy and balneology.

[The modern role of the resort medicine in medical diplomacy and national humanitarian policy]. / Sovremennaya rol' kurortnoi meditsiny v meditsinskoi diplomatii i natsional'noi gumanitarnoi politike.

Health care in general and medicine in particular play an important role in the geopolitical landscape and the political positioning of the state in the modern world. The health of the citizens of the country is the most important resource of national security. This article, based on a SWOT-analysis, highlights the strengths and weaknesses of the foreign and national resort industry as a part of medical diplomacy, with decomposition to its individual participants. The undoubted advantage of our country in terms of humanitarian policy, on the world stage is shown, specifically in the context of national key success factors, including the technological capabilities of domestic medical science and practice, regarding the availability of trained staff, specialized variable climatic sanatorium and resort institutions network with unique technologies and natural healing resources, coupled with international experience in humanitarian cooperation, developed healthcare system and sanitary and epidemiological supervision of the country. Medical diplomacy and national resort medicine as an active participant of the branch, are strategically important areas in public diplomacy, having the ability to play an important role in achieving national goals in geopolitics.

[Modern view on upper limb physical rehabilitation after stroke. Literature review]. / Sovremennyi podkhod k fizicheskoi reabilitatsii funktsii verkhnei konechnosti posle insul'ta. Obzor literatury.

Stroke is the world's second leading cause of death and the first cause of disability among all diseases. The most common complication of a stroke is a violation of the motor function of the limbs, which significantly worsens the quality of life and the level of self-care and independence of patients. Restoring the function of the upper limb is one of the priority tasks of rehabilitation after a stroke. A large number of factors, such as the location and size of the primary brain lesion, the presence of complications in the form of spasticity, impaired skin and proprioceptive sensitivity, and comorbidities, determine the patient's rehabilitation potential and the prognosis of ongoing rehabilitation measures. Of particular note are the timing of the start of rehabilitation measures, the duration and regularity of the treatment methods. A number of authors propose scales for assessing the rehabilitation prognosis, as well as algorithms for compiling rehabilitation programs for restoring the function of the upper limb. A fairly large number of rehabilitation methods and their combinations have been proposed, including special methods of kinesitherapy, robotic mechanotherapy with biofeedback, the use of physiotherapeutic factors, manual and reflex effects, as well as ready-made programs that include sequential and combined use of various methods. Dozens of studies have been devoted to comparative analysis and evaluation of the effectiveness of these methods. The purpose of this work is to review current research on a given topic and draw up our own conclusion on the appropriateness of using and combining these methods at various stages of rehabilitation in stroke patients.

[Cervicogenic vertigo]. / Tservikogennoe golovokruzhenie.

The prevalence of cervical dizziness, still not recognized by the entire medical community, not only does not become less frequent, but even increases today. This phenomenon is facilitated by the widespread computerization of our lives and, in particular, the strain on the neck when working with portable electronic equipment. Despite the fact that criteria that reliably confirming the association of dizziness with cervical pathology have not yet been defined, experimental and clinical evidence of such an association continues to accumulate. This review presents data from studies of the last few years on cervical pathology as a causative factor in some types of dizziness and vertigo. To date, the following variants of cervical vertigo are distinguished: Barre-Lieu syndrome, rotational vertebral artery syndrome, proprioceptive cervical vertigo, migraine-associated cervical vertigo. The paper considers the features of all four cervical vertigo types, as well as methods for diagnosing and the first randomized trials on the treatment of dizziness associated with the pathology of neck structures. The results of own observations of similar cases (diagnosis and treatment) are described; as well as principles of differential diagnosis of some conditions manifested by headache and dizziness in patients with various types of disorders of cervico-cranial region. The similarities of clinical presentation and pathogenetic mechanisms characteristic of skull base and neck anomalies, Meniere's syndrome and cervical vertigo are discussed. In conclusion, an assumption was made about the common origin of a whole group of the diseases associated with the cranio-cervical region.

[Health resort care of people with disabilities in the Russian Federation]. / Sanatorno-kurortnoe lechenie invalidov v Rossiiskoi Federatsii.

OBJECTIVE: To analyze the health resort care (HRC) system for people with disabilities and provide the rationale of the HRC system improvements. MATERIAL AND METHODS: A content analysis of the regulatory framework and analysis of data from the Forms of Federal Statistical Monitoring of Rosstat, the Russian Ministry of Health, and the Russian Ministry of Labor were performed. RESULTS: The 19 main legal and regulatory documents are presented, and the 16 main areas of legal regulation on the HRC organization are highlighted. For 2014-2018, a twofold decrease in the number of people with disabilities whose individual rehabilitation and habilitation program included recommendations for HRC was observed. In 2019 and 2020, an increase in this indicator was recorded. An overall decrease in the number of persons (including children) with disabilities who received HRC was demonstrated. CONCLUSION: Ways to improve the HRC system for people with disabilities was identified.

[Patient-centered approach using COPM, GAS scores in medical rehabilitation of patients with tetraplegia after spinal cord injury]. / Patsientoorientirovannyi podkhod s ispol'zovaniem shkal COPM, GAS v reabilitatsii patsientov s tetraplegiei posle pozvonochno-spinnomozgovoi travmy.

OBJECTIVE: To study the efficacy of the patient- and task-oriented approach and specific therapeutic exercises (TE) for the arms in patients after spinal cord injury at the cervical level. MATERIAL AND METHODS: The study included 119 patients with a history of spinal injury of more than one year. They were divided into three demographically comparable groups. Group 1 patients (control) received standard of care: TE, physiotherapeutic treatment, social adaptation (SA), and massage; Group 2-standard of care and specific TE for the arms as part of the SA; Group 3-the same as Group 2 combined with the patient- and task-oriented approach (patient-selected activities were trained). Outcomes were assessed at the beginning (T1), end (T2), and at 1 year (T3) after a 30-day medical rehabilitation course. RESULTS: No statistically significant differences between the groups in demographic, neurological (ISCSCI score), motor (FIMm, VLT scores), psychological parameters (depression, anxiety), quality of life (WHOQOL-BREF score) before the medical rehabilitation (T1) were observed. At the end of the medical rehabilitation course (T2), the increase in functional scores was 6.0±5.4 points of FIMm score, 6.0±4.6 points of VLT score in group 1; 8.0±7.6 points of FIMm score, 7.0±7.1 points of VLT score in group 2; 9.0±6.9 points of FIMm score, 8.0±7.6 points of VLT in group 3. Significant differences were found between groups 1 and 2 and 3 on the domains of «finger I¼ (13.6±9.64 points vs. 15.2±9.40 and 15.3±9.21 points respectively), «fingers II-V¼ (9.4±6.76 points vs. 11.3±6.41 and 11.6±6.76 points respectively) of VLT score; between groups 3 and 1 on the domains «self-care¼ (25.9±9.67 points vs. 23.1±9.8 points), «transfer¼ (11.7±6.21 points vs. 10.6±6.1 points) of the FIMm score, and also the group 3 patients had a higher quality of life by 3.0±1.8 points. At delayed follow-up (T3-T2), no changes of the FIMm and VLT scores were detected within groups. In group 3, 69% of problems were identified in self-care (COPM); subjective assessment of functional improvement for COPM (T2-T1) was as follows: «performance¼ 4.7±1.27 points, «satisfaction¼ 3.8±1.63 points; for GAS the T-score at the end of rehabilitation was 1.3±0.55 points, and the greatest significance of change was noted for COPM under «performance¼ (ES=0.73), with the correlation coefficient between FIMm and COPM being 0.55 and 0.63 for «performance¼ and «satisfaction¼ domains, respectively. CONCLUSION: Patient- and task-oriented approach implemented by using COPM questionnaire and GAS score together with specific TE for arms is an effective method of motor medical rehabilitation of patients with posttraumatic cervical tetraplegia. This approach improves their quality of life, while parameters of subjective scores (COPM, GAS) have the same sensitivity in comparison with the conventional motor scores (FIMm, VLT).

[Upper limb motor and functional recovery in patients with tetraplegia]. / Vosstanovlenie dvigatel'nykh funktsii verkhnei konechnosti u patsientov s travmoi sheinogo otdela spinnogo mozga.

OBJECTIVE: To study the recovery of the upper limb motor function and functional independence in patients with cervical spinal cord injury. MATERIAL AND METHODS: The study included 49 patients with subacute tetraplegia, mean age 33±14.8 years, 42 men and 7 women, admitted to the Preodolenie Rehabilitation Center. The follow-up was up to 2 years. The clinical and functional states were assessed after 3, 6, 12 and more than 12 months after spinal injury, using the ASIA neurological standard scale, the motor subscale of Functional Independence Scale (FIM) and short form of Van Lieshout Test (VLT). All patients received continuous rehabilitation courses that included physiotherapy, occupational therapy, social support, psychological rehabilitation. RESULTS: Upper limb motor recovery occurred in the first 6 months after spinal cord injury at 5±3.9 points (ASIA), while in 49% patients motor level decreased by one segment of the spinal cord, in 8% patients completeness of spinal cord injury improved. The improvement of functional independence was found during the first 12 months: according to FIM, in the period of 3-6 months by 18±11.1 points, in the period of 6-12 months by 8±8.1 points; according to VLT in the period of 3-6 months by 19±14.4 points, in the period of 6-12 months by 5.6±6.02 points. CONCLUSIONS: Upper limb motor recovery mostly occurs in the first 6 months while the functional independence improvement lasts during the first 12 months after a spinal cord injury.

[Rehabilitation problems in Top Rated Databases]. / Problemy reabilitatsii v vysokoreitingovykh bazakh dannykh.

Development of medical rehabilitation technologies are the investments into «human capital¼. The effectiveness criterion of the scientific institutions work dealing with the problems of rehabilitation is the scientific publication activity of their employees in this subject in high-ranking international databases (DB).Purpose of the study. Analysis of the state of the scientific publication flow in the field of rehabilitation. MATERIAL AND METHODS: Data from the Web of Science and Scopus databases for November 2019, depth from 1991 to 2018 were used. RESULTS: It was revealed that the high level of the publication rating of Russia, which was noted in 1991-1992, has not yet been achieved in the Scopus database for medical rehabilitation. Measures have been identified to enhance it by increasing the growth rate of the Russian publication flow. It also noted the necessity to reduce Russia's dependence on the monopoly of foreign publishing corporations by creating domestic Russian resources and borrowing the experience of foreign colleagues. CONCLUSION: The necessary measures should be taken at the level of authors, scientific organizations, the scientific community and the State in order to increase the Russian scientific publication flow in the direction of «Rehabilitation¼ in foreign top-rated databases. Authors of interdisciplinary articles need to correctly present metadata indicating the relation of the work to the problem of rehabilitation. The necessity is substantiated not only to increase the share of Russian scientific journals in international databases, but also to create domestic high-rating databases, as well as to harmonize the existing regulatory legal acts in regards of terms and definitions in the field of rehabilitation, to bring the headings of the Universal Decimal Classification aligned with the headings of high-ranking international databases. Given the high social significance of the «Rehabilitation¼ area, it is necessary to include it in the priority list and funded areas at a level corresponding to global trends.

[Chondroitin sulfate role in the complex rehabilitation of elderly people with chronic pain syndrome]. / Rol' khondroitina sul'fata v kompleksnoi reabilitatsii lits pozhilogo vozrasta s khronicheskim bolevym sindromom.

The article presents the data of the latest domestic and foreign original studies, the results of a number of meta-analyses, conclusions of randomized clinical trials (RCTs), and other scientific studies that prove the effectiveness and necessity of mandatory inclusion in the treatment of chronic pain syndrome of the stage of non-invasive non-pharmacological therapy. One of the promising areas of pharmacotherapy for degenerative-dystrophic joint lesions is the use of chondroprotectors (CP), in particular chondroitin sulfate (CS). According to new Clinical Recommendations of Ministry Health (MH) of the Russian Federation (RF) «Chronic pain in patients of elderly and senile age¼ (2020), according to which the purpose of CS is recommended for patients older than 60 years with joint pain and contraindications to non-steroidal anti-inflammatory drugs (NSAIDs) or senile asthenia for the purpose of pain relief and the prevention of exacerbations of pain. A high level of reliability and persuasiveness of the recommendations was noted (1A) of CS use. Most of the CS is available in the form of forms for oral use, the bioavailability of which, according to clinical studies, is 13-38% due to the destruction of the CS molecules in the gastrointestinal tract. Intramuscular (i/m) administration of the drug can increase the bioavailability of CS, which can not only increase the effectiveness of therapy, but also lead to a more rapid development of the symptomatic effect. In Russia available parenteral forms of CS (Chondroguard) pharmaceutical quality, efficacy has been proven in randomized clinical trial (RCT) MH RF. To relieve pain in the joints, it is recommended to use parenteral forms of CS (Chondroguard) at a dose of 100-200 mg per day, every other day, the total duration of the course of treatment is 25-30 injections.

[Therapeutic effects of climototherapy: scientomatrical analysis of evidence-based studies]. / Lechebnye effekty klimatoterapii: naukometricheskii analiz dokazatel'nykh issledovanii.

OBJECTIVE: Scientometrical analysis of studies the use of climatotherapy methods and formulation of guidelines based on the evidence obtained during the analysis. MATERIAL AND METHODS: The article presents the data of scientometrical analysis of 40 publications on the use of climatotherapy in spa practice. RESULTS: Clinical effects and proposed mechanisms of action of the proven efficacy climatotherapy methods - aerotherapy, heliotherapy and thalassotherapy for the patients with various chronic diseases are presented. The clinical directions for the using of climatotherapy methods in climatic resorts are highlighted. CONCLUSIONS: Regular generalization and analysis of existing evidence-based studies is required, as well as the implementation of new high-quality randomized controlled clinical trials to study the effects of climate therapy on a wide range of patients with common socially significant diseases.

[Comparative analysis of functional independence predictors in patients with cervical tetraplegia]. / Sravnitel'nyi analiz prediktorov funktsional'noi nezavisimosti u patsientov s tservikal'noi tetraplegiei.

Purpose of the study was to investigate clinical predictors of functional independence in patients with cervical tetraplegia at different periods after a spinal cord injury (SCI). MATERIAL AND METHODS: 190 patients (151 men and 39 women) with an SCI from 3 months to 6 years old were included in a retrospective study. The average age was 27 years. The examination was carried out using the international standard for neurological classification of spinal cord injury (ASIA) with the definition of motor score ASIA for the upper extremity (ASIA upper extremity), neurological (NL) and motor levels (ML), and the completeness of spinal cord injury (AIS). Functional assessment was performed using the FIM motor subscale. The study of neuromuscular conduction of the median nerves - according to stimulation electroneuromyography (SENMG). The degree of functional independence was assessed as a severe disability with FIM less than 42 points, mild and moderate - FIM 42 points or more. RESULTS: Using logistic regression analysis, it was found that in the first 6 months after SCI, the main predictors are ASIAupper extremity (AUC=0.84; X2=3.32; p=0.06) and NL (AUC=0.80; X2=2.96; p=0.09). When observed in the first 12 months, ASIAupper extremity (AUC=0.86) remains the leading predictor. Moreover, pronounced functional limitations can be predicted using predictors of ASIAupper extremity in 84.4% and completeness of injury (AIS) in 81.2% of cases, moderate and mild limitations - ASIAupper extremity in 81.4%, NL in 86.0% and functional tenodesis (FT) in 100% of cases. In the long-term period (more than 12 months), the exceptional predictive power of the predictor ASIAupper extremity (AUC=0.92) is noted both in the prediction of severe (82.5%) cases and moderate and mild functional disorders (91.8% of cases). In addition, in the SCI long-term period, the predictor AIS plays a significant role in severe disorders (in 82.5% of cases), and NL (88.2%) and FT (100%) - in moderate and mild disorders. The boundaries between functional groups according to functional independence in groups of 12 months and more than 12 months after SMT are presented: ASIAupper extremity 22.4 and 22.6 points, ML more than 6.5 and the presence of FT with a ML of more than 5.6, respectively. At the same time, the results of SENMG showed low predictive significance. CONCLUSION: Motor score ASIAupper extremity is a leading predictor in all periods after SCI, while completeness of spinal cord injury (AIS) more accurately predicts pronounced functional limitations, and ML and FT predict moderate functional limitations. The FT, a neurological level of C6 and higher, a motor score ASIA upper extremity of more than 22 points are criteria for achieving moderate functional independence.

[Medical rehabilitation: domestic scientific publication stream]. / Meditsinskaya reabilitatsiya: otechestvennyi nauchnyi publikatsionnyi potok.

The formation of a high-tech healthcare system is provided for by national projects. The expected effectiveness of the implementation of these projects is possible only with full-fledged scientific support, which is reflected in the publication scientific rating of Russia in highly rated international databases (DB). THE PURPOSE: Of this work is to analyze the Russian scientific publication stream on medical rehabilitation against the background of the world array of publications and its forecast for the near future. MATERIAL AND METHODS: The data of Web of Science and Scopus DB has investigated. Analysis of Russian scientific publications was carried out at various hierarchical levels of the DB: for Web of Science - across the entire DB (5 sections), under the section «Life Sciences and Biomedicine¼, under the subsection «Rehabilitation¼; for Scopus - in the division of knowledge «Medicine¼ (SUBJAREA (medi)), as well as in the subject area «Rehabilitation¼. The publication scientific rating of Russia was evaluated against the background of the world rating. Analysis of DB information was carried out for the period 1991-2018. RESULTS AND CONCLUSION: For the period 1991-2018, the highest quantity of domestic publications on rehabilitation in the international rating databases Web of Science and Scopus was in 1991: 5.5% (3rd place out of 53 in the world ranking) and 2.3% (6th place out of 64), respectively. The forecast of the dynamics of the quantity, taking into account the data of this period, showed that Russia has practically reached this high level in Scopus, and at the current rate of growth in the publication activity of Russian scientists, in the Web of Science, it can only reach it by 2028.

[Medical rehabilitation of patients with pneumonia associated with the new COVID-19 coronavirus infection]. / Meditsinskaya reabilitatsiya patsientov s pnevmoniyami, assotsiirovannymi s novoi koronavirusnoi infektsiei COVID-19.

Effective medical rehabilitation of patients with pneumonia caused by the new SARS-CoV-2 coronavirus is critical for the recovery and optimization of emergency and specialty care outcomes. In this regard, it is relevant to develop a scientifically based medical rehabilitation program for patients with the coronavirus infectious disease COVID-19, whose composition and structure includes methods and tools that have proven effectiveness. AIM: To develop evidence-based approaches to medical rehabilitation for patients with pneumonia associated with the new COVID-19 coronavirus infection. RESULTS: The clinical effects and suggested mechanisms of action of rehabilitation technologies in patients with pneumonia, including those associated with the new COVID-19 coronavirus infection, are considered in Detail. The most studied of the physical methods that have a proven effect are physical exercises, breathing exercises, the complex effect of factors of resort therapy, hydrotherapy, which affect the main clinical manifestations of the underlying disease, astheno-neurotic syndrome and increasing immunity. Clinical recommendations for medical rehabilitation are proposed and its promising methods are considered. CONCLUSION: Regular generalization and analysis of high-quality randomized controlled clinical trials to evaluate various physical methods of treatment of patients with pneumonia associated with the new COVID-19 coronavirus infection is Necessary, which serve as a basis for the development of future valid clinical recommendations. Timely and adequate specialized medical rehabilitation care is critical to maintaining the health, reducing disability and mortality of patients with pneumonia associated with the new COVID-19 coronavirus infection.

[Funtional tenodesis as a predictor of functional outcome in patients with cervical tetraplegia]. / Funktsional'nyi tenodez kak prediktor funktsional'nogo iskhoda u patsientov s tservikal'noi tetraplegiei.

AIM: To determine the value of functional tenodesis (FT) of the hand as a predictor of the degree of disability in patients with cervical tetraplegia (CT) at different periods after a spinal injury. MATERIAL AND METHODS: We examined 190 patients (79% - men) with CT (92.5% of cases of traumatic origin) at the age of 27 [21.0; 36.0] years with a neurological level of CІІІ-DІ, and a share of complete motor damage (A - B according to AIS) 70%. The examination included determination of neurological, motor levels and completeness of spinal cord injury (according to ISNSCI), assessment of functional independence (FIM motor domain), FT of the hand, and the severity of contractures of the joints of the hand. Using logit-regression analysis, creation of contingency tables, ROC analysis, depending on the timing of spinal injury, 4 classification models were studied: Disease duration less than 6 months, assessment of the functional outcome 6 months after spinal injury (model A); disease duration less than 6 months, assessment after 12 months (model B); disease duration less than 12 months, assessment after 12 months (model C); disease duration more than 12 months, evaluation after more than 12 months (model D, primary one). RESULTS: FT developed in the first 6 months after spinal injury in 12 (24%) patients, in 6-12 months - in 15 patients (20%), in more than 12 months - in 1 (less than 1%) patient. The incidence of joint contractures of the hand in group A (20%) and C (24%) did not have a statistical difference (χ2=0.22; p=0.64). Hand contractures in the first 6 months were observed in 20% of patients, in the first 12 months - in 24%, more than 12 months after spinal injury - in 28% of patients. In model A, the FT sensitivity was 80%, specificity was 64%, AUC - 0.65; in model B - 85%, 36%, 0.36, respectively; in model C (log-regression χ2=19.1; p was not determined) - 69%, 100%, 0.59, respectively; in model D (log-regression χ2=55.3; p was not determined) - 65%, 100%, 0.71, respectively. CONCLUSION: FT and contracture of the joints of the hand form during the first year after the debut of CT. As a predictor of a pronounced limitation of self-care, the sensitivity of FT in the first 6 months after spinal injury was 80-85%, in the later period, the specificity of FT was 100%, and sensitivity was 65-69%; in general, the predictive power of FT was low (AUC 0.36-0.71) and increased with the assessment of the functional outcome in the period of more than 12 months after the injury.

[Gastroesophageal reflux disease with cardial manifistations: perspectives of non-pharmacological treatment methods]. / Gastroézofageal'naia refliuksnaia bolezn' s kardial'nymi proiavleniiami: perspektivy nemedikamentoznykh metodov lecheniia.

In this article we present the review of the literature and our own research regarding gastroesophageal reflux disease (GERD) with cardiac manifestations. The methods of treatment of patients with GERD using mineral waters, physio- and balneotherapeutic factors, as well as acupuncture are discussed. The conclusion is drawn about the effectiveness of the use of non-pharmacological methods in mono- and complex therapy of GERD and the need for further research in this direction.

[The application of the pulsed low-frequency electrostatic field in pediatrics]. / Primenenie impul'snogo nizkochastotnogo élektrostaticheskogo polia v pediatrii.

One of new methods for the physiotherapeutic treatment in pediatrics is the application of the pulsed low-frequency electrostatic field the action of which is based on the effects of deep resonant vibration on the affected tissue region with the minimal mecha-nical impact. Under the influence of the electrostatic field, the tissues at the site of interest become tightened and descend which causes their vibration due to the alternation of the pulses and intervals between them. The fast consecutive repetition of this process results in rhythmical deformation of the tissues. The electrostatic pulses are responsible for the increased friction between separate parts of the tissues while in the intervals between the pulses the tissue elastically resists their influence. In this way, the tissues subjected to such influence 'are pumped over' throughout their depth. It leads to the restoration of elasticity and mobilization of separate fibers and layers inside the tissue as well as to the development and improvement of the blood flow in the tissues and their blood supply. During the recent years, a large number of reports have been published in the literature concerning the possibilities of application of the pulsed low-frequency electrostatic field for the treatment and prevention of various di-seases in the children, including both monotherapy and its combination with other therapeutic modalities. The favourable action of the pulse low-frequency electrostatic field on the clinical course of bronchial asthma, mucoviscidosis, I and II degree scoliosis in the young children, remittent multiple sclerosis in the adolescents has been demonstrated. The data obtained give evidence of the high effectiveness of the proposed method, its excellent tolerance, and a wide range of beneficial effects on the main pathogenetic components of the diseases which creates the good prerequisites for the further active introduction of the therapeutic phy-sical factors in the practical work of the children's medical organizations.

[The differential algorithm for the prescription of the stabilizing training to the patients following replacement arthroplasty of the lower extremities]. / Algoritm differentsirovannogo naznacheniia stabilotreninga dlia patsientov posle éndoprotezirovaniia sustavov nizhnikh konechnostei.

BACKGROUND: The biological feedback-based stability (balance) training is used for the rehabilitation of the patients following replacement arthroplasty of the lower extremities with the purpose of restoration of their postural balance. AIM: The objective of the present study was to develop a differential algorithm for the prescription of the stability training to the patients after they had undergone the endoprosthetic replacement of the joints of the lower extremities. MATERIAL AND METHODS: The study included 48 patients presenting with the following nosological forms: hip arthrosis with total replacement arthroplasty and gonarthrosis with total replacement arthroplasty. All the patients underwent the biofeedback-based stability training with the use of the dynamic balance Pro-Kin system ('Technobody', Italy) using the 'Skiing' No. 10 computer game during 20 minutes every day. The clinical and instrumental methods were employed for the purpose. RESULTS: The rehabilitation subgroups of the patients who had undergone the were distinguished for the first time based on the identification of the main risk factors. It was shown that the main factors having the most pronounced influence on the recovery of postural balance under the conditions of stability training with biological feedback include the age, the time after surgery, the results of evaluation using the Spielberger-Hanin anxiety scale and the Bek depression scale, the level of co-morbidity, the risk of falling estimated from the Morse-Fall scale, and the results of the digit-symbol test based on the Wegsler intelligence scale. CONCLUSION: The distinguishing between rehabilitation subgroups allowed to develop the differentiated algorithm for the prescription of the stability training with biological feedback for the purpose of restoration of the patients' postural balance following total replacement arthroplasty of the lower extremities.