Vol 21, No 1 (2022)

According to the regulatory documents, from January 1, 2022, medical care is provided on the basis of clinical protocols. At the same time, the assessment of the entire volume of regulatory and legal documentation remains an urgent and complex task today, requiring special attention of a physiotherapist due to the fact that the section non-drug methods of treatment and rehabilitation is mandatory for any clinical protocol. Thus, a physiotherapist should have up-to-date information on almost all clinical protocols and standards of medical care. Physiotherapy is also presented in the standards of treatment of patients of various profiles and ages, which are often published earlier than the relevant clinical protocols or are the only regulatory document.

For ease of use, the standards and clinical protocols have been grouped according to the clinical and anatomical principle in tabular form. For each group of nosologies, only non-drug methods of treatment with a multiplicity of use and frequency of provision are allocated. The ways of solving the imperfections of the regulatory framework in the context of physiotherapy at various levels are proposed. Methods of integration of documents regulating medical activity into the practice of work of an outpatient physiotherapist are described.

BACKGROUND: Recently, there has been an increase in early complications after localized exposure to low temperatures (cryolipolysis) for the treatment of localized fat deposition. Carboxytherapy is a method that improves the condition of the microcirculatory bed and reduces swelling.

AIM: to develop and evaluate the use of a personalized method of injection carboxytherapy in patients with adverse events (edema and neuropathy) after hardware methods of correction (cryolipolysis) of local fat deposits.

MATERIAL AND METHODS: The study involved 45 patients aged 32–43 years with a diagnosis of "E65 Localized fat deposition", who received early complications (local edema and a change in sensitivity at the site of exposure to the cryopapillary ― in the sub-umbilical region) after the cryolipolysis procedure (hardware non-surgical correction of local fat deposits). Before the start of treatment, all patients underwent genetic testing according to the "Cosmetology" panel. Three groups were identified, which received injection carboxytherapy locally, paravertebral in the projection of the lumbosacral region, or a combination of both.

RESULTS: When analyzing data after a course of treatment, patients with an extended carboxytherapy protocol showed a significant improvement in the quality of life, both in the immediate and in the long-term study period. This was expressed in a statistically significant decrease in intradermal edema and a rapid regression of the pain syndrome in the main group compared to other study groups.

CONCLUSION: In patients with early local complications after cryolipolysis, the use of injection carboxytherapy is justified not only locally but also paravertebral, which significantly reduces the recovery period, contributes to a more rapid reduction of local edema and neuropathy phenomena, and also allows obtaining a stable clinical result. Personalized injection carboxytherapy is an effective factor in the relief of complications after cryolipolysis.

BACKGROUND: Interval hypo-hyperoxic training is a new promising technology in medical rehabilitation, including the rehabilitation of patients with post-COVID syndrome. However, the mechanisms of therapeutic action of interval hypo-hyperoxic training in the recovery period after suffering COVID-19 have not been fully studied. The effectiveness of interval hypo-hyperoxic training largely depends on the method of interval hypo-hyperoxic training.

AIM: to develop modes and study the effectiveness of the use of interval hypoxic training in patients with post-COVID syndrome.

MATERIALS AND METHODS: The performed open randomized comparative study involved patients with a diagnosis of post-COVID syndrome ― "Condition after COVID-19" according to the ICD (code U09.9). Patients of the main group, against the background of a course of traditional rehabilitation treatment, received interval hypo-hyperoxic therapy from the OXYTERRA device. In the comparison group, patients received only a traditional course of rehabilitation treatment. The study was conducted for 4 months. To assess the effectiveness of interval hypo-hyperoxic training before and after the course of rehabilitation, we studied the dynamics of the parameters of the circulatory system and the function of external respiration.

RESULTS: 50 patients (19 women, 31 men, mean age 61.7±7.7 years) were randomly divided into the main group (n=30) and the comparison group (n=20). All patients completed a full course of rehabilitation. It was established that the course of training with interval hypo-hyperoxic training contributed to an increase in the oxygen capacity of the blood, an increase in the oxygen content in arterial blood, a decrease in heart rate, normalization of the level of systolic and diastolic pressure, restoration of stroke and minute blood volume parameters in patients of the main group. Interval hypo-hyperoxic training caused an improvement in the functional state of the bronchopulmonary system (p <0.049). There was an improvement in the activity of the central ergotropic and humoral-metabolic mechanisms of heart rhythm regulation, correction of the activity of the sympathetic link of regulation and the modulating effect of the parasympathetic division on the heart rhythm, normalization of the vagosympathetic balance coefficient.

CONCLUSION: The use of interval hypo-hyperoxic training in the recovery period in patients with post-COVID syndrome according to the developed method caused a stable improvement in the clinical condition, which lasted from 3 to 6 months after the completion of complex rehabilitation.

BACKGROUND: Post-stroke cognitive impairments negatively affect the results of rehabilitation, worsening the outcomes of motor functions recovery, daily activity, and also increase the likelihood of recurrent stroke and premature death. Therapeutic physical factors contribute to the activation of the body's reserve capabilities and aim at correcting metabolic and vascular disorders, improving the functional status of the nervous system, which allows them to be used in a complex of rehabilitation measures.

AIM: to substantiate the use of dynamic electric neurostimulation in the correction of cognitive impairment in patients in the early recovery period of ischemic stroke.

MATERIALS AND METHODS: A prospective cohort study of 60 patients in the early recovery period of ischemic stroke, with mild and moderate cognitive impairment, at an average age of 62.4±4.5 years, divided by random sampling into 3 groups: group 1 (n=25), in addition to the basic rehabilitation complex, which included medication, sessions with a neuropsychologist, massage and physical exercise therapy, received a 15-day course of dynamic electric neurostimulation from the "Neurodance-PCM" device; group 2 (n=20) received the basic rehabilitation complex and procedures from the placebo device similar to procedures on "Neurodance-PCM"; group 3 (n=15) received only the basic rehabilitation treatment. All patients underwent an assessment of cognitive status using the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB) and the study of psychophysiological status on the psycho-physiological tester "NS-Psychotest", using the following tests: tapping test, the Schulte–Platonov tables with red-black cells, test of simple visual-motor reaction, reaction to a moving object test.

RESULTS: Over the two-week rehabilitation, it was found that the inclusion of dynamic electrical stimulation, in addition to the standard therapy of cognitive impairment in patients in the early recovery period of ischemic stroke, improves attention, memory, speech fluency, generalization functions, complicated choice reaction, increases the functions of visual attention and the speed of sensorimotor response, which was not noted in the comparison groups.

CONCLUSIONS: The inclusion of dynamic electric neurostimulation in the rehabilitation complex of patients in the early recovery period of ischemic stroke with mild and moderate cognitive impairment may affect cognitive functions by stimulating the third block of the brain according to A.R. Luria and improving the neurodynamic support of higher mental functions.

The relevance and the urgent character of the problem of traumatic arthropathy of the knee joint in children is due to the high frequency of injuries of this localization, comprising from 5 to 25% of all injuries of the musculoskeletal system.

Nowadays, physical factors are commonly used at different stages of medical rehabilitation of children with traumatic injuries of the knee joint. At the same time, scientifically substantiated recommendations for medical rehabilitation of children with nonspecific posttraumatic knee pain syndrome are insufficient.

Studies conducted have ascertained the effectiveness of local air cryotherapy, which is characterized by an explicit anti-edema, analgesic effect. An early regression of pain has been registered, the elimination of microcirculatory disorders in the area of damage as a result of the course effects of pulsed low-frequency magnetic therapy at various stages of medical rehabilitation. The beneficial effect of a pulsed low-frequency electrostatic field on the indicators of orthopedic status, the state of microcirculation, thermography in the area of damage has been established in children with traumatic arthropathy of the knee joint.

The possibility of using polychromatic polarized light in traumatic arthropathy of the knee joint in children, characterized by pain reduction due to muscle relaxation, activation of microcirculation in the injury area, restoration of the volume of movements, has been proved.

Nowadays the leading place in the structure of diseases of children in the perinatal period, is occupied by the perinatal lesion of the central nervous system. Special attention should be paid to the issue of minimal use of medicines in children with perinatal pathology, which is why one of the main tasks of medical rehabilitation is still the development and scientific justification of new methods of kinesitherapy.

To study the results of research conducted by Russian and foreign authors on the issues of physical rehabilitation of children with perinatal damage to the central nervous system and to conduct an analysis of the effectiveness of the proposed technologies. The literature review for this article was conducted from the eLibrary, PubMed, Cochrane Library databases with a search depth of 10 years. The selection of publications was carried out using keywords: non-drug technologies; perinatal damage to the central nervous system; perinatal hypoxic-ischemic encephalopathy; kinesotherapy; neurodevelopmental therapy; massage, thin finger training method; dry immersion; fitball gymnastics; V. Voit therapy; Bobat therapy.

It is shown that the motor development of a child in the first year of life is the most important criterion in the formation of further processes of structural and functional maturation of the nervous system. Medical rehabilitation of children with perinatal lesions of the central nervous system is aimed at improving blood supply and metabolic processes in brain tissue, stimulation of neuromuscular conduction and normalization of central and peripheral regulation of muscle tone.

Currently, the issues of substantiating the use of various physical factors in the medical rehabilitation of children with perinatal lesions of the central nervous system from the standpoint of evidence-based medicine remain relevant.