Vol 19, No 2-1 (2017)
Articles
The modified Rankin scale is a universal tool for assessment the independence and disability of patients in medical rehabilitation
Abstract
This article is devoted to the description of a universal tool for assessment the independence, disability of patients and the need for external assistance for medical rehabilitation. The Rankin scale is valid for assessing patients of any profile, regardless of pathology. In the article the rules of estimation according to the Rankin scale are given, the features of the evaluation on the scale at different stages of rehabilitation and under different pathologies are analyzed. The authors emphasize that the scale is universal since it does not focus on individual types of pathology and symptoms, but rather assesses the patient's possibilities for self-care and movement, and also the need for help from other people in everyday life.
Consilium Medicum. 2017;19(2-1):8-13
8-13
14-16
Early recovery period of stroke: the possibility of the use of cholinergic drugs
Abstract
The article showed the importance of applying the cholinergic drugs in the treatment of patients in an early recovery period of the stroke. The purpose of the study was to evaluate the efficacy of the drug ipidacrine in complex therapy of patients in the early recovery period of ischemic stroke with moderate motor and cognitive disorders. Materials and methods. 62 patients in the early recovery period of stroke were enrolled; (mean age 62.34±5.7 years). The main group included 32 patients with stroke which along with the standard treatment regimen, received ipidacrine 20 mg 1 tablet 3 times a day for a month. The control group consisted of 30 patients with stroke receiving standard treatment regimen. We assessed the dynamics of the neurologic status of patients, scales and questionnaires. Results and conclusion. The study demonstrated high efficacy of ipidacrine in the treatment of patients in the early recovery period of stroke: reliable improvement of motive and cognitive functions, emotional violations, reduction of expressiveness of a pain syndrome is shown.
Consilium Medicum. 2017;19(2-1):17-24
17-24
Special considerations on spasticity syndrome correction in patients with focal central nervous system lesions
Abstract
Focal lesions of the central nervous system often lead to spastic paresis with significant deterioration of motor control and decreased quality of life. Alleviation of excessive muscle tone with botulinum toxin A injections coupled with motor skill learning are essential for motor rehabilitation. Botulinum toxin therapy should be included into the structure of multimodal rehabilitation to decrease muscle tone and to provide conditions for adequate motor rehabilitation. The algorithm of rehabilitation measures for stroke and traumatic brain injury patients should be based on a stage-by-stage approach to medical care and multidisciplinary rehabilitation procedures.
Consilium Medicum. 2017;19(2-1):25-30
25-30
The potential role of the orthopedic surgeon in current rehabilitation of patients with upper-limb spasticity
Abstract
The rehabilitation of patients with spastic paralysis of upper extremities is very important. It explains the high incidence of diseases and complication of spasticity. It leads to the formation of specific limb deformities and dysfunctions. If patient doesn’t have any correct rehabilitation or it absence, neurological dysfunctions leads to orthopedic disorders. The modern approach to the rehabilitation of such patients includes close interdisciplinary interaction. Despite this, a superficial analysis of the published data showed extremely rare participation in orthopedist in multidisciplinary teams. That is why we lose orthopedic problems of deformation because of spasticity. Distal surgery allows to potentiate the effect of conservative methods of rehabilitation medicine, and in some cases is way to overcome a plateau rehabilitation. However, for the formation of the indications for surgical treatment requires adequate assessment of the musculoskeletal system, the degree of patient adaptation and rehabilitation potential, which was not revealed in the analysis of patient’s histories. Initiate closer interdisciplinary interaction with involvement in the healing process of all the necessary specialists, including orthopedic and reconstructive surgeons, will implement joint inspections and consistent filling of standardized cards containing evaluative characteristics presented in categories of the International Classification of Functioning, relevant to all interested professionals. The optimal content of maps, data would be to characterize the patient from the standpoint of the ICF.
Consilium Medicum. 2017;19(2-1):31-43
31-43
Stem nonspecific reflex-muscular syndromes
Abstract
Comprehensive survey of 314 patients with pathology of the spine and joints of large possible to distinguish three nonspecific reflex muscle syndrome (syndrome pathological orthostatic stabilization synergies, pathological syndrome stabilize locomotor synergy and pathological syndrome stabilization extensor-adductor-pronatsionnory synergy) implemented by forming pathological lesions in the excitation of the brain stem. Isolated syndrome can be successfully used as a sort of algorithms that regulate the order guides purposeful application of a wide range of treatment and rehabilitation (massage, physiotherapy, physical therapy).
Consilium Medicum. 2017;19(2-1):44-48
44-48
The use of the method of robotic kinesitherapy in patients with sequelae of stroke
Abstract
Recovering gait skills is one of the most important tasks of rehabilitation of post-stroke patients. In recent years robotic devices have been used extensively in physical rehabilitation for the gait recovery. The article presents the results of the study of efficiency of using robotic kinesiotherapy in complex rehabilitation of patients after stroke. There were organized medical examinations of 50 patients, including 50 in the main group with the use of the robotic complex ‘Locomat’ and 42 patient in control group with the use of conventional physical therapy. As a result, there are statistical differences in regard to the indices of mobility, motor skills and sensitivity in paretic limb, strength and muscle tone in paretic limbs, as well as the overall improvement of daily activity. It has been determined that the use of robotic devices has positive impact in rehabilitation of post-stroke patients.
Consilium Medicum. 2017;19(2-1):49-52
49-52
To the question about theoretical substantiation of clinical and psychological approach to rehabilitation of diseased with reduced level of consciousness
Abstract
In the article the question about rehabilitation of patients with reduced consciousness level are raised. The theoretical substantiation of methods are presented, related to stimulation of analyzer systems. These methods are used by psychologists and physiologists during the rehabilitate of patients consciousness, who are in coma, sopor, etc. In the conclusion the list of difficult and unsolved questions are presented, related to the application of multimodal sensory stimulation in rehabilitation work.
Consilium Medicum. 2017;19(2-1):53-55
53-55
Public awareness of aphasia: a survey of clinicians
Abstract
Aphasia (loss of language abilities following focal brain damage) creates communication barriers and can dramatically affect the quality of life. Social activity and quality of life of individuals with aphasia may be particularly negatively affected by the society being poorly informed and thus not able to integrate them. Additionally, rehabilitation outcomes are highly dependent on aphasia awareness of patients’ caregivers. We conducted a survey of clinicians to gauge the current level of public awareness of aphasia in Russia. This paper outlines the survey results and suggests ways to increase public awareness of aphasia and of the crucial role of speech-language pathologists in neurorehabilitation.
Consilium Medicum. 2017;19(2-1):56-59
56-59
Determination and correction of cognitive disorders at patients with cardiovascular diseases
Abstract
Pathogenic causes and clinical features of vascular cognitve disorders were studied in this article. The role of serotonin in the development of vasoconstriction causing decrease of cerebral blood circulation was identified. Dusopharm affect treating light and moderate disorders was studied. The assessment data of clinical effectiveness and safety of Dusopharm use at patients with vascular cognitive disorders in out patient clinical practice were demonstrated.
Consilium Medicum. 2017;19(2-1):60-63
60-63
Correction of cognitive impairment in patients with craniocerebral trauma
Abstract
Article is devoted to the review of the modern foreign and domestic publications devoted to a problem of cognitive impairments in case of the traumatic brain injury (TBI) including questions of a definition and classification of TBI, frequency and the nature of cognitive, behavioral and emotional disorders in case of a brain injury, the sequence of restoration of cognitive functions, to approaches to treatment and rehabilitation of cognitive impairments. Questions of drug treatment of cognitive impairments, and also the analysis of the known techniques of rehabilitation, including personal, group occupations, the computerized technologies of recovery training are considered.
Consilium Medicum. 2017;19(2-1):64-69
64-69
The role of neurodegenerative pathology in the formation of post-stroke cognitive impairment
Abstract
In the following article discusses the main features of pathogenesis, clinic, diagnostics and differential diagnostics of post-stroke cognitive decline of vascular and mixed (vascular and degenerative) genesis. Cognitive impairment often seen after stroke and make a significant contribution to disability of patients. However, stroke is not always the main cause of post-stroke cognitive dysfunction. Many patients often have concomitant neurodegenerative process, mostly represented by Alzheimer's disease. This pathology can potentiate the development of acute cerebral insufficiency. In turn, the stroke can lead to the manifestation of clinically asymptomatic Alzheimer's disease. The presence of two parallel running processes (vascular and neurodegenerative) determines the severity of cognitive impairment and its character. Thus, the more rapid progression of cognitive dysfunction observed inpatients with post-stroke cognitive decline of mixednature. This situation leads to the poor outcome of the disease. Therefore, it is necessary to conduct differential diagnosis of isolated vascular cognitive disorders and cognitive decline of mixed etiology, which can help us to improve prognosis of disease.
Consilium Medicum. 2017;19(2-1):70-77
70-77
Possibilities of correction of psychoemotional disorders among patients in acute period of ischemic stroke by the method of dynamic electroneurostimulation
Abstract
Cerebral stroke continues to be an important medical and social problem. Often it is accompanied by depression, which, due to the reduction of initiative and motivation of patients, prevents their active participation in the rehabilitation activities. The purpose of this research is to study the effectiveness of the inclusion of dynamic electroneurostimulation (DENS) in the rehabilitation of persons in the acute period of ischemic stroke for the correction of psychoemotional disorders, such as post-stroke depression, anxiety and low level of motivation. Materials and methods. A total of 47 patients (24 men and 23 women, mean age 64.4±2.2 years) with acute ischemic stroke has been examined. A psychological and psychometric study in dynamics has been held (in accordance with BDI scores, Spielberger test, questionnaire “The motivation for success and motivation for fear of failure” - A.Rean's questionnaire). Clinical evaluation of neurological status was supplemented by scoring the neurological deficit on Lindmark scale. In addition to medical treatment, DENS therapy has been carried out for 15 days. Monitoring of the status of the control group of patients (36 people), corresponding to the study group by sex, age and severity of neurological symptoms, was conducted simultaneously. Patients in this group received only standard therapy. Results. The severity of depression and anxiety in the main group significantly decreased (by 4.0 points on Beck scale, and 8.6 points on Spielberger scale), while in the control group significant differences in indices were not detected (1.6 and 3.0 points, respectively). A.Rean's questionnaire analysis showed that during treatment, motivation level in the study group increased significantly, and the patients were oriented to success. While in the control group, significant changes in the level of motivation did not happened. Conclusion. Thus, the study showed that DENS is effective for the treatment of depression and anxiety among patients with ischemic stroke, and contributes to higher motivation of these patients.
Consilium Medicum. 2017;19(2-1):78-81
78-81
The experience of the combined application of dynamic electroneurostimulation and acupuncture in acute period of ischemic stroke
Abstract
In order to study the effectiveness of combined acupuncture methods, the examination and the early rehabilitation course for 70 patients with acute ischemic stroke, divided by random sampling into 3 groups, were held. In the main group (30 people), the basic treatment complex was optimized by the combined use of dynamic electroneurostimulation (DENS) and acupuncture. Monitoring of the status of two comparison groups (20 people each), corresponding to themain group by sex, age and severity of neurologic symptoms was conducted simultaneously. In the first comparison group, basic therapy was supplemented with DENS, in the second - with acupuncture. Assessment of the severity of neurological deficit was carried out on the scale NIHSS, to assess the patient's activities of daily live after a stroke, Barthel ADL index was used. Monitoring was carried out in the 1st and 15th day from the beginning of treatment. Positive dynamics was observed in all groups, however, in the main group at the end of the course of treatment, significantly higher scores (p<0.01) on all scales were obtained, compared with the comparison groups. In the main group (where patients received DENS therapy combined with acupuncture), on the 15th day from the beginning of treatment, a decrease of neurological deficit on the NIHSS scale was 5.2 points, Barthel Index increased for 30 points. Thus, the combination of two highly effective techniques (DENS and acupuncture) in one procedure causesa more pronounced recovery of lost functions among patients who had cerebral ischemic stroke and, therefore, more rapid adaptation to everyday life.
Consilium Medicum. 2017;19(2-1):82-85
82-85
Endothelial dysfunction is a pharmacological target for therapy of affective disorders in patients with cardiovascular diseases
Abstract
Endothelial dysfunction is considered as a common link in the pathogenesis of anxiety and depressive disorders and cardiovascular diseases. The broad spectrum of biologically active substances is represented by the laboratory markers of endothelial dysfunction that applied for diagnostics of endothelial impairment. Pharmacotherapy of endothelial dysfunction allows optimizing management and improve prognosis of patients with cardiovascular diseases and affective disorders.
Consilium Medicum. 2017;19(2-1):86-89
86-89
Ergotherapy. The role of restoring activity and participation in the rehabilitation of patients
Abstract
The article discloses the special analysis of human activity, applicable occupational therapists in routine practice, decrypts the concept of "activities therapy", gives an overview of the concepts of "activities of daily living" and "life cycle" used by occupational therapist in planning the intervention.
Consilium Medicum. 2017;19(2-1):90-93
90-93
Vertigo in the elderly age: the features of the course and the possibility of rehabilitation
Abstract
Complaints of dizziness and imbalance are often found in elderly patients. The age features of the vestibular receptors of the labyrinth and vestibular centers of the central nervous system are presented, as well as the visual and proprioceptive systems involved in maintaining equilibrium. The authors cite the algorithm for clinical examination of an elderly patient with dizziness using both simple tests and complex diagnostic equipment. The most frequently observed vestibulopathies, the features of their diagnosis and the principles of rehabilitation in old age are considered.
Consilium Medicum. 2017;19(2-1):94-97
94-97
Infection of the urinary tract with spinal cord injury
Abstract
This lecture is for medical students, residents, urologists, neurologists and rehabilitologist. The aim of the presented material is the explanation of the etiology, pathogenesis, diagnosis, treatment and prevention methods of urinary tract infection in patients with spinal cord injury based on data from studies carried out in recent years, and the results of our own work. The result of the lecture is a statement of the main stages of treatment, and methods of prevention of urinary tract infection in patients with spinal cord injury.
Consilium Medicum. 2017;19(2-1):98-101
98-101
Analysis of the work of the neural rehabilitation department of "Zelenaya roshcha" sanatorium for 2011-2015
Abstract
In work are provided job analysis of neurorehabilitation department of sanatorium "Zelenaya roshcha" (the III stage of rehabilitation) for 2011-2015. Positive dynamics in the form of growth of improvement of sanatorium treatment at patients with acute violation of cerebral circulation in early and late the recovery periods is noted: from 97.4% in 2011 to 98.9% in 2015. Implementation of the III stage of rehabilitation (sanatorium treatment) of patients after rendering specialized, including high-technology medical care that will allow to increase efficiency of programs of rehabilitation of patients, will reduce by 1.5-2.1 times the morbidity and mortality among patients with stroke and a positive impact on their health status and to improve the quality of life of the patients.
Consilium Medicum. 2017;19(2-1):102-106
102-106