Russian Journal of Physiotherapy, Balneology and Rehabilitation

This work aimed to systematically review and quantitatively synthesize the evidence on the efficacy of modern rehabilitation strategies compared with standard care in adults with post-stroke aphasia and/or dysarthria for outcomes including verbal communication, speech comprehension, naming function, quality of life, and cognitive function. A systematic search was conducted in PubMed, ScienceDirect, eLIBRARY, and Google Scholar for the period 2015–2025. Randomized controlled trials evaluating modern rehabilitation interventions in patients with post-stroke aphasia/dysarthria were included. Risk of bias was assessed using the RoB 2 tool. Meta-analysis was performed using a random-effects model with standardized mean difference (Hedges’ g) as the effect measure. Heterogeneity was evaluated using the Q-test, I², and τ² statistics; publication bias was assessed visually and with Egger’s test. Thirteen RCTs were included (total participants: 1601 in the intervention groups, 1364 in the control groups). Methodological quality assessment revealed low risk of bias in 9 studies (69.2%) and moderate risk in 4 (30.8%). Meta-analysis showed a statistically significant positive effect of rehabilitation interventions on naming function (Hedges’ g = 0.992; 95% CI 0.283–1.700; p = 0.0114; I² = 0.9%). The greatest effect was observed with combined approaches (rTMS + M-MAT) and high-intensity therapy in the chronic phase. For verbal communication (g = 0.323; 95% CI −1.177–1.822; p = 0.642) and quality of life (g = 0.136; 95% CI −0.169–0.440; p = 0.318), no statistically significant improvements were found. Evidence for dysarthria supports the efficacy of Liuzijue Qigong breathing exercises. Modern rehabilitation strategies show proven efficacy in improving naming function in post-stroke aphasia, particularly with high-intensity therapy in the chronic phase and in combination with rTMS. For dysarthria, breathing techniques are the most effective. The lack of effect on verbal communication and quality of life highlights the need for more sensitive outcome measures and long-term programs. Personalized rehabilitation approaches that account for stroke phase and further research into combined strategies are needed.

BACKGROUND: The article presents the results of a clinical study of repetitive transcranial magnetic stimulation (rTMS) in children with migraine.

AIM: To evaluate the efficacy and safety of rTMS in children with migraine.

METHODS: A open-label, single-arm, prospective cohort clinical study was conducted in 41 pediatric patients with migraine (mean age 12.34 ± 3.42 years) at Children’s City Polyclinic No. 39 in Moscow. In stage 1, we used rTMS of the left primary motor cortex at 70% of the motor threshold, 10 Hz (6-sec train, 45-sec inter-train interval), 600 stimuli per session, 3 sessions. If efficacy parameters were not achieved within one month (≥50% reduction in pain intensity and/or ≥30% reduction in the number of monthly headache episodes), patients were transferred to stage 2 with the following parameters: 10 daily sessions (excluding weekends) , 10 Hz, 70% of the motor threshold, 4-sec train, 11-sec inter-train interval , and 3000 stimuli per session. Efficacy was assessed based on changes in headache diary parameters, questionnaire scores, and instrumental findings.

RESULTS: In stage 1, 21.9% of patients achieved the efficacy criteria. In stage 2, positive changes were observed in headache intensity and frequency (p < 0.001): 28% of patients had a ≥50% reduction in pain intensity; 100% of patients had a ≥30% reduction in headache frequency. The HADS depression subscale score decreased by 41.7% (p < 0.001); the Spielberger–Hanin anxiety scale score decreased by 5.8 points for trait anxiety and by 7.6 points for state anxiety (p < 0.001); positive changes were observed on the CPAQ-R (5.2%, p = 0.003), and PedsQL (11.9%, p < 0.001).

CONCLUSION: rTMS of the left primary motor cortex significantly reduces the number of episodes and intensity of migraine headaches in children, reduces symptoms of anxiety and depression, positively affects quality of life and functional nervous system parameters, and is characterized by a favorable safety profile and good tolerability. Increasing the number of stimuli and sessions improves efficacy and increases the proportion of patients with a successful outcome.

BACKGROUND: Population aging is a global healthcare challenge, and the key mechanisms of age-related changes include oxidative stress, chronic systemic inflammation (inflammaging), reduced neuroplasticity, and microcirculatory disorders. The most promising strategy for correcting these disorders in spa settings is the use of non-pharmacological technologies—cryotherapy, hydrogen therapy, pressotherapy, and transcranial magnetic therapy.

AIM: To provide a pathogenetic rationale and comparative evaluation of the efficacy of non-pharmacological technologies (cryotherapy, hydrogen therapy, pressotherapy, and transcranial magnetic therapy) as tools for correcting age-related disorders that act through key aging mechanisms in spa settings.

Methods: A prospective, controlled, comparative, and randomized study was conducted in 150 patients aged 50–70 years with a verified diagnosis of “practically healthy.” Basic therapy provided to all patients included therapeutic exercise, diet therapy, balneotherapy, and climatotherapy. Using simple fixed randomization, the patients were divided into five groups: control (basic therapy alone), cryotherapy (basic therapy + whole-body air cryotherapy), hydrogen therapy (basic therapy + molecular hydrogen inhalation), pressotherapy (basic therapy + lymphatic drainage pneumatic compression), and transcranial magnetic therapy (basic therapy + a low-frequency magnetic field). The efficacy of correcting age-related disorders was assessed by changes in oxidative stress parameters (malondialdehyde, superoxide dismutase, catalase), systemic inflammation markers (interleukin-6, interleukin-1β, high-sensitivity C-reactive protein), neuroplasticity (brain-derived neurotrophic factor, Montreal Cognitive Assessment score), and microcirculation (laser Doppler flowmetry).

RESULTS: The course of treatment was accompanied by positive changes in the evaluated parameters, the magnitude of which differed significantly between study groups. Comparative analysis revealed that hydrogen therapy was most effective for correcting oxidative stress, cryotherapy for suppressing systemic inflammation and improving microcirculation, transcranial magnetic therapy for enhancing neuroplasticity and cognitive function, and pressotherapy for optimizing lymphovenous outflow. The most pronounced anti-inflammatory and microcirculatory effects were observed with whole-body air cryotherapy, while transcranial magnetic therapy convincingly demonstrated a unique capacity to increase brain-derived neurotrophic factor levels and improve cognitive status.

CONCLUSION: A course of non-pharmacological technologies in spa settings contributes to significant correction of key pathophysiological mechanisms of aging. The high therapeutic potential of each technology is based on the ability of a physical agent to exert a specific corrective effect: hydrogen therapy on oxidative stress, cryotherapy on systemic inflammation and microcirculation, transcranial magnetic therapy on neuroplasticity, and pressotherapy on lymphovenous outflow. These findings support a personalized selection of non-pharmacological technologies based on the predominant mechanism of age-related impairments.

Background: Diabetic retinopathy is one of the most severe and late vascular complications of diabetes mellitus and is one of the leading causes of blindness and low vision worldwide. Laser photocoagulation is an effective and proven treatment for this disease; however, it carries certain risks and side effects. In this regard, it is important to identify medical technologies that allow reducing the volume of laser treatment.

AIM: To evaluate the safety and efficacy of transcutaneous electrical nerve stimulation (TENS) for reducing the effective volume of retinal laser photocoagulation in patients with preproliferative diabetic retinopathy.

Methods: An open-label prospective randomized controlled clinical trial included 89 patients with preproliferative diabetic retinopathy who were divided into two groups: the study group (43 patients) underwent retinal laser photocoagulation on the day after a course of TENS; the control group (46 patients) underwent laser photocoagulation alone. Ophthalmological examination was performed before treatment and at 2, 4 weeks, and 3 months.

Results: In the study group of patients who had received TENS, there were significantly fewer laser burns and the applied photocoagulation power was reduced. At all follow-up time points, patients in both groups showed comparable and statistically significant improvement in best-corrected visual acuity and reduction in central retinal thickness due to decreased diffuse edema. Differences were noted only in electrophysiological parameters after TENS at 3 months.

Conclusion: A course of TENS with individually adjusted parameters (based on the Kerdo index) in patients with preproliferative diabetic retinopathy is effective as a preoperative preparatory step for retinal laser photocoagulation, significantly reducing the effective volume of laser treatment, as evidenced by a reduction in both power (by 28%) and the number of laser burns (by 5%) compared with the control group. The same therapeutic effect in the study group was achieved with fewer and less powerful laser burns.

BACKGROUND: The method is based on the induction of high-density eddy currents that affect excitable structures in deep tissues. The distinctive features of vortex pulsed magnetic fields (VPMF) include high magnetic induction values, tens of times higher than those generated by conventional magnetotherapy devices; the high sensitivity of biological tissues to them; short pulse durations (100–200 µs), ensuring the safety of the method during high-intensity stimulation; and a high rate of magnetic field change, leading to the induction of strong electrical fields and currents in body structures. Key components of the analgesic effect of VPMF include improved microcirculation and tissue oxygenation, modulation of nerve conduction, anti-inflammatory effects, stimulation of repair processes, regulation of bone metabolism, endorphin-mediated effects, and others.

AIM: To evaluate the efficacy and optimize protocols for the use of high-intensity pulsed magnetic fields generated by the EMW MED device in the treatment of pain syndromes of various etiologies.

METHODS: A single-center, prospective, descriptive, cohort, observational pilot study was conducted. To assess the qualitative and quantitative characteristics of pain before and after a course of high-intensity pulsed magnetic field exposure, the following clinical tools were used: the visual analog scale (VAS) for pain; the DN4 neuropathic pain diagnostic questionnaire; the Pain Detect questionnaire; and the self-assessment questionnaire. Statistical analysis was performed using Statistica (version 12.6). The Shapiro–Wilk test, recommended for small sample sizes (fewer than 50 observations), was used to determine the distribution. Between-group differences were assessed using Student’s t-test. The results are presented as M ± m (where M is the mean and m is the standard error of the mean); p < 0.05 was considered significant.

CASE DESCRIPTION: The study included 37 patients whose clinical presentation was dominated by pain syndrome, including patients with dorsopathy, with lower extremity polyneuropathy, and 10 patients with traumatic lower leg amputation due to combat injury—after a mine-blast wound of the lower limb with neuropathy and phantom pain. A course of magnetic stimulation was associated with a reduction in pain intensity on the VAS (p < 0.05) in all three study groups; the total DN4 score was below 4 points in all three groups, which is below the threshold for neuropathic pain; and the Pain Detect score decreased to the level indicating that the presence of a neuropathic pain component is unlikely. Self-assessment questionnaire scores increased significantly in all three groups. No adverse events or reactions were observed during high-intensity pulsed magnetic stimulation.

CONCLUSION: These results provide sufficient evidence for the analgesic efficacy of high-intensity pulsed magnetic stimulation in pain syndromes that are predominantly neuropathic.