Vol 21, No 4 (2022)

BACKGROUND: Taking into account the role of angiogenesis processes in the zone of development of immature scar tissue, it seems pathogenetically justified to use a vascular laser for the correction of hypertrophic skin scars that are at the maturation stage. In this regard, we used a pulsed dye laser, the effect of which is perceived by the patient without pronounced pain, and the technology itself is quite safe and leads to a rapid recovery of the skin after the procedure. Fermencol phonophoresis supplementation of laser therapy with pulsed dye laser has the potential to enhance the therapeutic efficacy of a vascular laser, since Fermenkol is a preparation of collagenases of hydrobiont origin that can destroy the components of the extracellular matrix, the formation of which exceeds in intensity its degradation by matrix metalloproteinases at the stage of formation scar. The use of ultrasound in this case not only accelerates the delivery of proteolytic enzymes, but also exhibits independent fibromodulatory activity.

AIM: comparative evaluation of the effectiveness of the use of physiotherapeutic factors (Fermenkol phonophoresis, pulsed dye laser therapy and their combination) in patients with immature hypertrophic skin scars, taking into account clinical research methods.

MATERIAL AND METHODS: The study was performed on 125 patients aged 19 to 50 years with immature (less than 6 months) hypertrophic skin scars. All patients were divided into 4 groups according to the simple fixed randomization procedure. The first group (control, 32 patients) received course local compression therapy using silicone plates for two months. The second group (31 patients) was treated with phonophoresis of 0.01% Fermencol gel. The third group (31 patients) was treated with pulsed dye laser. The fourth group (31 patients) received complex treatment, including a combination of two pulsed dye laser procedures and two cycles of Fermencol phonophoresis. Patients were examined twice: before the start of treatment and 2 weeks after the end of the course of treatment. The assessment of the clinical condition of patients was carried out according to the modified Vancouver scale for assessing the signs of cicatricial deformity.

RESULTS: Conducting a course of treatment of patients with immature hypertrophic skin scars made it possible to establish a good tolerability of the effects of physiotherapeutic factors. At the same time, the positive dynamics of clinical manifestations of cicatricial changes in the skin, assessed by Vancouver scar scale, in the control and main groups was not the same and increased in the following order: Control < Fermencol phonophoresis < pulsed dye laser < pulsed dye laser + Fermencol phonophoresis. The use of the correlation adaptometry technique, which makes it possible to objectify the obtained clinical data, evaluating them using the category of functional reserves of the body, confirmed that the best clinical result was achieved in the group recieved combined use of pulsed dye laser and Fermencol phonophoresis.

CONCLUSION: The conclusion was made about the maximum therapeutic effect in the group of complex use of pulsed dye laser and ultrasound administration of an enzyme preparation, which manifested itself due to the synergistic type of interaction between two physiotherapeutic factors that have different modalities, points of application and mechanisms for implementing their therapeutic activity.

BACKGROUND: The problem of medical rehabilitation/habilitation of patients with diseases of the nervous system, mental disorders, congenital anomalies and developmental delays is extremely relevant. The article analyzes the comprehensive care for this category of patients on the basis of the State Budgetary Institution Center for Comprehensive Rehabilitation of the Disabled "Butovo".

AIM: analysis of the volume and methodology of prescribing physical factors in the provision of medical and social services to patients at the State Budgetary Institution Center for Comprehensive Rehabilitation of the Disabled "Butovo".

MATERIALS AND METHODS: In 2021, based on archival data for 2019–2020 an assessment was made of the conduct of socio-medical rehabilitation at the State Budgetary Institution Center for Comprehensive Rehabilitation of the Disabled "Butovo". The observation unit is represented by stationary patient charts.

RESULTS: The study revealed a sufficient volume and correct methodology for prescribing physical factors to patients with diseases of the nervous system, mental disorders, congenital anomalies and developmental delays. At the same time, the absence of an adequate goal of rehabilitation/habilitation was noted. The goals that were set for patients were often unrealizable, non-specific, not defined in time, or not related to the needs of the patient himself.

CONCLUSION: A unified comprehensive approach is needed to assess the condition, identify needs and implement rehabilitation measures for patients with diseases of the nervous system, mental disorders, congenital anomalies and developmental delays. It has been determined that in this category of patients it is advisable to apply the International Classification of Functioning, which will allow one to concentrate on the necessary areas of diagnostics, select the necessary diagnostic tools, identify and link functional disorders and disability to each other, determine the areas of intervention of different specialists, unite specialists into one team with overall goal of rehabilitation/habilitation.

BACKGROUND: Total knee arthroplasty is one of the most common surgical interventions in the world and the Russian Federation. Endoprosthetics of the knee joint occupies a leading place in the structure of surgical methods for the treatment osteoarthritis.

AIM: of the study was to scientifically substantiate the feasibility of the complex use of electrical stimulation and therapeutic exercises in patients after total knee arthroplasty.

MATERIALS AND METHODS: We examined 60 patients who were admitted 3 months after TCS and were randomized into 2 groups. In the first group, 30 subjects received electrical stimulation of the quadriceps muscles and underwent therapeutic exercises, for a course of 10 procedures. The subjects of the second group, 30 people, had only physiotherapy exercises.

RESULTS: The use of electrotherapy and physiotherapy exercises, in the complex treatment of patients after total knee arthroplasty, improves the function of joint mobility. This is confirmed by the improvement in the functional activity of the operated joint according to the KSS scale (Кnee Society Scores), the improvement in the state of microcirculation and the positive dynamics of the pain syndrome according to the VAS (Visual Analog Scale). The obtained data of the HAQ (Health Assessment Questionnaire) questionnaire testify to the expansion of the possibilities for performing most of the activities in everyday life. However, more statistically significant results were obtained in patients after a course of quadriceps electrical stimulation and therapeutic exercises compared with the use of therapeutic exercises alone.

CONCLUSION: The complex of rehabilitation of patients after total knee arthroplasty presented by us, including electrostimulation and therapeutic gymnastics, is scientifically sound, effective and can be implemented into the basic scheme of outpatient and sanatorium treatment of this category of patients.

Suspension systems occupy a special place in the rehabilitation of people with a neurological and orthopedic profile, forming a stable basis for safe movement exercises at various stages of recovery.

Mental retardation as a nosological group has its own secondary disorders of physical development, which require separate corrective and preventive work, without which stable compensatory mechanisms that have a defective basis can form.

In view of the peculiarities of the perception of information, a special approach is required to the choice of tools and means of work for correctional and preventive and correctional rehabilitation classes. When analyzing the content component of the TRX-system (Total Body Resistance Exercises) method, it was determined that it can include the implementation of all necessary areas of work for children with mental retardation and be available for adaptation. The main provisions of the TRX-training methodology for children with mental retardation are aimed at: developing static and dynamic postural control; correction of violations of the walking pattern; correction of major secondary disorders of the musculoskeletal system, such as impaired posture, flat feet, valgus position of the ankle and knee joints.

And, given that one of the main violations of this nosological category is a violation of the coordination of both the coordination of movements and the coordination of the neuromuscular interaction, this feature forms additional advantages of the method, due to its profile.