Vol 24, No 5 (2025)

Acute cerebrovascular accident remains one of the leading causes of disability and mortality, with persistent risks of developing and progressing cognitive and functional impairments even in the late recovery period. The urgency of this issue drives the search for innovative approaches to rehabilitation and quality-of-life improvement in such patients. Interval hypoxic conditioning technology, particularly in the form of intermittent hypoxic–hyperoxic training, represents a promising non-pharmacological approach capable of enhancing neuroplasticity, synaptogenesis, and cerebral hemodynamics. The aim of this review is to analyze the therapeutic potential of intermittent hypoxic–hyperoxic training in the context of post-acute cerebrovascular accident rehabilitation, including its effects on molecular adaptation mechanisms, angiogenesis, and functional recovery. Methodology involved a systematic search in PubMed, Scopus, eLIBRARY.RU, and other databases, focusing on studies related to hypoxic preconditioning, neuroprotection, and clinical outcomes. The results demonstrate that intermittent hypoxic–hyperoxic training activates HIF-1α–dependent pathways, stimulating angiogenesis through VEGF and neurogenesis via BDNF, as confirmed by both experimental and clinical data. Moderate intermittent hypoxia (9%–16% O₂) optimizes the redox balance, suppresses proinflammatory cytokines (IL-6, TNF-α), and enhances antioxidant defense through Nrf2, correlating with reduced ischemic damage. Clinically, intermittent hypoxic–hyperoxic training procedures improve cognitive function (memory, attention) and motor performance, especially when combined with aerobic training, increasing exercise tolerance (e.g., 15%–20% improvement in the six-minute walk test) and quality of life. Cardioprotective effects include normalization of blood pressure and reduction of oxidative stress markers (malondialdehyde), which is particularly relevant for patients with multimorbidity. Integration of intermittent hypoxic–hyperoxic training into multimodal rehabilitation programs contributes to synergistic effects, enhancing neurovascular remodeling. Despite its promise, further optimization of personalized protocols considering age and comorbidities, as well as randomized trials to assess long-term safety, are required. This review addresses neurologists, molecular biologists, and rehabilitation specialists, highlighting the translational potential of intermittent hypoxic–hyperoxic training into clinical practice given further validation of its efficacy.

BACKGROUND: The high prevalence of scoliosis within pediatric orthopedic condition (up to 27.6%), the significant progression of the pathological process in adolescents (50%), and the risk of early disability in children (8%–9%) necessitate the development of innovative medical rehabilitation programs.

AIM: This study aimed to provide a scientific rationale for the combined use of dynamic electroneurostimulation and corrective therapeutic gymnastics with elements of the Katharina Schroth method in the medical rehabilitation of children with scoliosis.

METHODS: A randomized prospective study included 60 children aged 5–18 years with grade II scoliosis (36.7% boys and 63.3% girls). All patients were randomized into three equal groups. The main group received a combined program of dynamic electroneurostimulation and corrective therapeutic gymnastics with elements of the Schroth method. The first reference group received dynamic electroneurostimulation only, whereas the second reference group received corrective therapeutic gymnastics with elements of the Schroth method only.

RESULTS: The study demonstrated that only the main group, which received combined dynamic electroneurostimulation and therapeutic gymnastics with elements of the Schroth method, showed reductions in back muscle fatigue and dorsal pain under static and dynamic loads compared with children who received dynamic electroneurostimulation or therapeutic gymnastics alone (p <0.05). Regression of pathological changes in clinical and orthopedic status was recorded in the main group and the second reference group (p <0.05). The most significant increase in median strength endurance of the back and abdominal muscles was observed in the main group patients. In the longitudinal analysis of scoliometry parameters, only children in the main group showed an increase in the medians of thoracic spine parameters (p <0.05). Longitudinal laser Doppler flowmetry analysis of the thoracic spine revealed an increase in the mean values of microcirculation (M) and perfusion variability (σ), more pronounced in children receiving combined dynamic electroneurostimulation and therapeutic gymnastics or therapeutic gymnastics alone.

CONCLUSION: The study confirmed the feasibility of applying dynamic electroneurostimulation both alone and in combination with therapeutic gymnastics incorporating elements of the Schroth method in children with grade II scoliosis. The therapeutic efficacy of the combined use of dynamic electroneurostimulation and therapeutic gymnastics in children was statistically significant (p <0.05) and amounted to 75.0% compared with therapeutic gymnastics incorporating elements of the Schroth method alone (68.8%) and dynamic electroneurostimulation alone (53.8%). Follow-up in 41.6% of children from all groups at 3 and 6 months after treatment completion confirmed the persistence of achieved results.

BACKGROUND: Muscular dystrophies are a broad and heterogeneous group of hereditary neuromuscular disorders, most commonly manifesting with primary symmetric involvement of proximal skeletal muscles in the upper and lower limbs. Patients with these disorders are at increased risk of muscle fiber damage if exercises and their intensity are inappropriately selected during physical therapy. At present, no neuroimaging markers are available to assess the safety of physical exercise in patients with inherited myopathies. Quantitative MRI criteria for detecting clinically significant changes in skeletal muscles have also not been developed.

AIM: This study aimed to evaluate the safety of physical therapy exercises in pediatric patients with muscular dystrophies using neuroimaging, clinical, and laboratory methods.

METHODS: The study included 86 patients with genetically confirmed Duchenne muscular dystrophy (mean age 7.5 ± 2.4 years) and 42 patients with limb-girdle muscular dystrophies (mean age 11.8 ± 3.3 years). All patients underwent a 4-month rehabilitation program consisting of aerobic physical therapy exercises, stretching, and cycle ergometer training. Safety was assessed using clinical, laboratory, and neuroimaging measures.

RESULTS: According to MRI findings, no statistically significant increase in T2 water signal intensity was observed after aerobic exercises without load in the major muscle groups of the pelvic and shoulder girdles, thighs, and calves in either group, indicating no progression of nonspecific inflammation or edema. All reported adverse events were mild and short-term, did not affect the rehabilitation, or require additional pharmacological or non-pharmacological treatment. Eight cases of skeletal muscle injury were observed, attributable to concentric or eccentric exercises. In the Duchenne muscular dystrophy group, the mean skeletal muscle signal intensity before exercise was 34.9 ± 1.0 ms and increased to 44.1 ± 3.7 ms during follow-up (p <0.01). In the limb-girdle muscular dystrophies group, signal intensity was 33.6 ± 2.3 ms and 44.3 ± 4.1 ms, respectively (p <0.01).

CONCLUSION: Thus, the developed rehabilitation program, which includes aerobic exercises without load, does not result in skeletal muscle damage in patients with various forms of muscular dystrophy, as confirmed by neuroimaging, clinical, and laboratory assessments. In patients with Duchenne muscular dystrophy, skeletal muscle MR signal intensity from water increased on average by 20.4 ± 5.8%, whereas in patients with limb-girdle muscular dystrophies it increased by 23.8 ± 6.3%. This increase is clinically significant and indicates skeletal muscle injury accompanied by corresponding symptoms.

BACKGROUND: The study of potential therapeutic approaches for post-COVID syndrome within randomized controlled trials remains one of the priority objectives.

AIM: This study aimed to evaluate the effect of transcranial electrical stimulation as an adjunct to monopharmacotherapy on depression, sleep disturbances, and plasma cortisol and serotonin levels in patients with post-COVID syndrome.

METHODS: The study included 150 patients with post-COVID syndrome randomized into two groups (75 each): the main group received transcranial electrical stimulation in addition to monopharmacotherapy, while the reference group received monopharmacotherapy alone. Treatment efficacy was assessed after 15 days using the HADS-D, ISI, CGI-S scales and plasma cortisol and serotonin levels.

RESULTS: After 15 days, statistically significant differences between the groups were observed in median scores on HADS-D (p=0.042), CGI-S (p=0.002), and ISI (p <0.001), as well as in cortisol (p=0.001) and serotonin (p=0.002) levels. The addition of transcranial electrical stimulation to monopharmacotherapy in patients with post-COVID syndrome resulted in complete remission of its manifestations in 95% of cases.

CONCLUSION: The findings support the use of transcranial electrical stimulation as an effective and pathogenetically justified component of comprehensive treatment in outpatients with post-COVID syndrome presenting with depressive symptoms and sleep disturbances.