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Vol 21, No 2 (2022)

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Original studies

Experience of use of the extended complex of ophthalmononeurostimulation in patients with non-exudative atrophic (geographic) form of age-of-aged macular degeneration

Drakon A.K., Korchazhkina N.B., Sheludchenko V.M.

Abstract

BACKGROUND: Non-exudative atrophic (geographic) macular degeneration of the retina is one of the causes of irreversible loss of central vision in the elderly. Its frequency of occurrence increases with age.

AIM: to evaluate the effectiveness of the extended complex of ophthalmoneurostimulation in patients with non-exudative atrophic (geographical) form of age-related macular degeneration.

MATERIAL AND METHODS: The study included 49 people (98 eyes) with geographic retinal atrophy, whose average age was 74±1.7 years, who were divided into 2 groups: group 1 ― 24 patients (48 eyes) aged 71.0±1.8 years, who underwent an extended complex of ophthalmoneurostimulation, including a course of endonasal electrophoresis of vitamin B12 (for a course of 10 daily procedures), transocular infrared stimulation (for a course of 10 daily procedures), oxygen therapy with Heliox-21 breathing mixture (for a course of 10 daily procedures), and acupuncture (for a course of 10 daily procedures), and group 2 ― 25 patients (50 eyes) aged 75±1.1 years, who underwent a course of conservative treatment with vitamins according to existing ophthalmological standards, which served as a background in group 1. Visual acuity was assessed (visual acuity), indicators of optical coherence tomography and optical coherence tomography with angiography function of the retina, local photosensitivity, autofluorescence of the retina and bioelectric potential in pattern-electroretinography. Studies were performed before therapy, after 2 weeks, 3 months, 6 months, and 12 months, after a course of treatment.

RESULTS: Visual acuity and anatomical parameters of the retina in high resolution (thickness of the central zone and the thickness of the choroid) did not change during the entire observation period. Analysis of light sensitivity showed a significant normalization of the average threshold of retinal photosensitivity when prescribing an extended complex of ophthalmoneurostimulation.

CONCLUSION: Conducted extended course of physiotherapy significantly reduced the functional depression of the central visual field, coordinating with foci of retinal pigment epithelium atrophy. Most likely, this positive effect was achieved due to the activation of the level of the ganglionic and bipolar layers of the retina.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2022;21(2):85-90
pages 85-90 views

Influence of complex application of heliox therapy and acupuncture on maximally corrected visual acuity in patients with acute form of central serous chorioretinopathy

Sheludchenko V.M., Drakon A.K.

Abstract

BACKGROUND: Central serous chorioretinopathy is a socially significant problem, as it is one of the most common diseases of the retina. It is more common in males of working age.

AIM: to evaluate the effect of the combined use of heliox therapy and acupuncture on the most corrected visual acuity in patients with acute central serous chorioretinopathy.

MATERIAL AND METHODS: The study included 34 men (34 eyes) with central serous chorioretinopathy, whose mean age was 36±2.3 years. The patients were divided into 2 groups comparable according to clinical and laboratory data: the main one ― 22 people, average age 32±3.1 years, who in the first two weeks received a complex of physiotherapeutic treatment, including: heliox 21, for a course of 10 daily procedures and acupuncture, also for a course of 10 daily procedures, and a control ― 12 people, average age 34±1.5 years, who, after consulting a neurologist, were prescribed medication (light sedatives, the Nutrof vitamin complex, diuretics 1 time in 3 days with restoration of electrolyte balance, alcohol restriction), which served as a background in the main group.

Visometry (visual acuity) was used to assess the effectiveness of treatment. Before treatment, after 2 weeks, after 1 month, 3 months, 6 months, 12 months.

RESULTS: Before treatment in patients with acute central serous chorioretinopathy, the maximum corrected visual acuity was reduced by 44.2% compared to the norm ― 0.95±0.05 (p <0.001) and comparable in the main group 0.54±0.05 and in the control group 0.53±0.05 (p=0.901). The maximum increase in visual acuity in patients of the main group was already two weeks later, with a subsequent increase in the indicator during the year, approaching the normal values at the last observation point (1 year). In addition, all patients after treatment noted a decrease in the intensity or exclusion of metamorphopsia. In the maximally corrected visual acuity control group, significantly less significant results were obtained at all control points.

CONCLUSION: Under the influence of the combined use of heliox therapy and acupuncture in patients with acute form of central serous chorioretinopathy, a more pronounced and persistent increase in maximally corrected visual acuity occurred compared to drug treatment.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2022;21(2):91-95
pages 91-95 views

Influence of physiotherapy on the electrical excitability of the shoulder muscles in the early postoperative period after radical surgical treatment of breast cancer

Evstigneeva I.S., Gerasimenko M.Y., Esimova I.E.

Abstract

BACKGROUND: Combined treatment of cancer patients includes a large number of aggressive therapies that lead to a complex of functional disorders. There are no publications on the influence of physical factors on the electrical excitability of the muscles of the shoulder girdle and upper limb from the side of surgery in the early period after surgical treatment of breast cancer.

AIM: To determine the physical factor that will most significantly affect the electrical excitability of the muscles of the shoulder girdle and upper limb on the side of the operation after radical surgical treatment of breast cancer.

MATERIAL AND METODS: A randomized, placebo-controlled study was conducted in 100 patients in the early postoperative period (2–4 days after surgery) for breast cancer. All patients underwent medical rehabilitation: individual physiotherapy exercises, balance therapy, sessions with a medical psychologist, physiotherapy treatment with a monofactor. The main group included 34 patients who included an extended method of fluctuorization in the course of medical rehabilitation and additionally underwent fluctuorization of the muscles of the forearm, group 2 (comparisons, n=33) the extended method of local magnetotherapy was included in the rehabilitation program and group 3 (comparisons, n=33) in addition to rehabilitation, general magnetic therapy procedures were performed. Patients underwent a study of the excitability of the neuromuscular system on the apparatus of stimulation and electrotherapy ASEtM-01/6 "Elesculap Med TeKo".

RESULTS: It was found that fluctuating currents turned out to be more effective in the early stages, which pathogenetically contribute to the restoration of conduction along the peripheral nerves and the activation and contractility of the muscle fiber. A delayed effect of local and general magnetic therapy on improving the contractility of the muscles of the upper limb and the conductivity of the peripheral nerve fiber was noted.

CONCLUSION: The inclusion of monophysical factors in the course of standard medical treatment, a course of physical therapy, exercises on a stabiloplatform and individual psychotherapy in the early stages (on days 2–4) after surgery contributed to the improvement in the functioning of the upper limb and the restoration of the electrical excitability of the muscles and nerves of the operated limb.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2022;21(2):97-106
pages 97-106 views

Immunological mechanisms of anti-inflammatory action of modified yellow clay in the experiment

Sagradyan G.V., Abramtsova A.V.

Abstract

BACKGROUND: Modern scientific search and reasonable introduction of new balneofactors into sanatorium-resort recreational technologies are conditioned by the results of fundamental research. Experimental balneology is faced with the tasks of investigating poorly studied natural sources that are potentially capable of having therapeutic and preventive properties.

AIM: is to evaluate immunological mechanisms of anti-inflammatory action of external balneological medicine based on natural clays to study their therapeutic effectiveness in diseases of musculoskeletal system of degenerative-dystrophic nature.

MATERIAL AND METHODS: An experimental study was conducted with the participation of 79 laboratory animals (male rats, Wistar line) distributed by simple sampling into 5 groups: in the control group 1 (n=15) there were healthy animals (intact); in the 2nd group (n=13) the animals had adjuvant arthritis (AA) without exposure; the 3rd group (n=17) had an adjuvant arthritis model and Tambukan dirt; in the 4th group (n=17) there was model adjuvant arthritis and a course of yellow clay, the 5th group (n=17) had model adjuvant arthritis and a course of modified clay. The anti-inflammatory effects of native and modified external balneological medicine were examined by evaluating the response of immune-competent cells of peripheral blood in reproducing chronic inflammation in adjuvant arthritis model.

RESULTS: The conducted studies have shown that the external use of modified yellow clay in the form of balneological medicine Glinofir is comparable to the effect of Tambukan dirt. According to the immune marker analysis there was a significant change in population lymphocyte structure in peripheral blood as a result of adjuvant arthritis modeling, namely, the number of B-lymphocytes increased (2.5 times; p <0.02) with simultaneous reduction of total T-lymphocytes (2.5 times; p <0.05); the level of circulating immune complexes showed a tendency to increase with the animals of the group with adjuvant arthritis model without treatment (59.8±4.18 units in adjuvant arthritis and 52.4±3.44 units with healthy animals; p=0.1).

CONCLUSION: According to the results of the experimental studies, Glinofir which has immune-modulatory and anti-inflammatory effects can be recommended for subsequent introduction into clinical practice as the treatment and medical rehabilitation of patients with diseases of musculoskeletal system of degenerative-dystrophic nature.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2022;21(2):107-113
pages 107-113 views

Evaluation of the effect of low-intensity rhythmic transcranial magnetic stimulation on motor and non-motor manifestations of Parkinson's disease

Borodulina I.V., Gerasimenko M.Y.

Abstract

BACKGROUND: The use of repetitive transcranial magnetic stimulation as a method of non-drug therapy of Parkinson's disease has been actively studied over the past decades. The prevailing number of repetitive transcranial magnetic stimulation protocols in Parkinson's disease use a high intensity of stimulation (80–120% of the value of the threshold of the evoked motor threshold from the muscles of the hand), while the choice of the stimulation intensity parameter was carried out empirically.

AIM: to study the effectiveness of low-intensity unilateral repetitive transcranial magnetic stimulation on motor and non-motor symptoms of Parkinson's disease.

MATERIAL AND METHODS:An open prospective non-randomized clinical trial included 37 patients with stage I–III Parkinson's disease according to Hoehn–Yahr (1967), akinetic-rigid and mixed (akinetic-rigid-tremor) forms. All patients underwent repetitive transcranial magnetic stimulation according to the protocol: M1 stimulation zone, frequency 5 Hz, intensity 40% of the cortical motor threshold, on 6s, off 8s, total number of pulses per session 3000. The course of treatment is 10 procedures with 2 days (weekend) off.

RESULTS: All patients completed the study in accordance with the protocol. When analyzing the results of the UPDRS scale (Unified Parkinson's disease rating scale), positive dynamics was noted in all parts of the questionnaire: part I ― from 2 (0; 3) to 0 (0; 1) points, p <0.05; part II ― from 9 (5.5; 12.5) to 4 (2; 6.5) points, p <0.05; part III ― with 11 (7; 14.5) to 6 (2; 7.5) points, p <0.05; part IV (Schwab and England scale) ― from 80% (70; 95) to 90% (85; 100), p <0.05. There was also a selective effect on non-motor symptoms.

CONCLUSION: Low-intensity exposure (40% of the motor threshold) has a significant clinical effect on motor and non-motor symptoms of Parkinson's disease; stimulation of the primary motor cortex can have an antidepressant effect; repetitive transcranial magnetic stimulation has a selective effect on non-motor symptoms of Parkinson's disease: a predominant effect has been demonstrated with respect to olfactory, emotional, cognitive disorders, sleep disorders and hypersalivation; when assessing the dynamics of motor disorders, a more pronounced effect was noted with respect to rigidity, postural disorders, walking speed, and to a lesser extent, the effect on tremor was noted.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2022;21(2):115-121
pages 115-121 views

Technology of magnetophoresis of topical nonsteroidal anti-inflammatory drugs in osteoarthritis (clinical and experimental study)

Osnovina I.P., Vladimirtseva E.L.

Abstract

BACKGROUND: The high degree of evidence for the use of pharmacotherapy currently does not cause doctors to doubt, however, the use of non-pharmacological approaches in general and physical factors in particular is the subject of many years of discussion for them. One of the main places in the pharmacotherapy of osteoarthritis is occupied by nonsteroidal anti-inflammatory drugs, while our interest is associated with a group of so-called topical drugs.

AIM: In order to methodically substantiate the application of the magnetophoresis technology of the topical form of nimesulide in an experimental study, the influence of the magnetic field on the spectroscopic and thixotropic characteristics of the drug was determined, and the clinical efficacy of the combined use of magnetotherapy and the transdermal form of nimesulide in comparison with the application of the drug and magnetic therapy with a pulsed low-frequency magnetic field was determined.

MATERIAL AND METHODS: A randomized study involving 60 patients with osteoarthritis of the knee joints was performed. The experimental part of the study on the effect of the magnetic field on the structure and properties of the gel form of the preparation containing 1% nimesulide (chemical formula: 4'-nitro-2'-phenoxy-methane sulfonanilide) was carried out in laboratory conditions. The clinical part of the study included the use of local therapy (application of nimesulide gel in an amount of 2–4 g) to the skin in the knee joint area, followed by the placement of inductors of the ALMAG+ magnetic therapy apparatus on the medial and lateral surfaces of the knee joint. The impact was carried out according to the recommended "3+1" program.

RESULTS: An analysis of the effectiveness of therapy conducted in a group of 60 patients with osteoarthritis of the knee joints showed high efficiency, expediency and safety of the use of the technology under study in the treatment of patients with joint diseases.

CONCLUSION: Due to the synergistic effect on the pathogenesis of articular syndrome, the gel form of nimesulide and the magnetic field have a unidirectional effect: anti-inflammatory, decongestant, analgesic, microcirculatory. In addition, the magnetic field enhances the absorption and flow of the drug into the tissues, being a physical enhancer (amplifier), which significantly affects the result of treatment.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2022;21(2):123-130
pages 123-130 views

Review

Low-level laser therapy in the supportive treatment of dermatologic adverse events in oncology

Polonskaia A.S., Shatokhina E.A., Kruglova L.S.

Abstract

Supportive treatment plays an important role in oncology nowadays. The main aims of oncologic supportive treatment are management of cancer symptoms and adverse events of cancer treatment.

In terms of dermatologic adverse events the most important types of reaction are oral mucositis during radiation therapy, chemotherapy and during hematopoetic stem cell transplantation, palmoplantar syndrome during chemotherapy, palmoplantar skin reaction, acneiform paronychia and pyogenic granulomas during targeted therapy, immune-related dermatologic adverse events during immunotherapy.

During recent years, special attention has been paid to low level laser therapy for the prophylaxis and management of cancer therapy dermatologic adverse events. The effects of low level laser therapy may have a beneficial effect on many conditions that play important roles in the pathogenesis of radiation and chemotherapy-induced complications in oncologic patients. Therapeutic effects of low level laser therapy are attributed to the stimulation of adaptive processes and to the increase of nonspecific resistance. The latter develop due to the close interaction of the immune, humoral and nervous systems. When choosing a method for the supportive treatment of cancer therapy adverse events, it is extremely important to establish safety in terms of the tumor process and absence of negative effects on cancer treatment.

Effects of low level laser therapy on the proliferative and invasive activity of an existing malignancy remains a matter of debate due to conflicting results from in vitro studies.

At the same time, according to the results of numerous clinical studies, the use of this method is assumed to be safe for cancer patients.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2022;21(2):131-141
pages 131-141 views

Clinical notes and case reports

Efficacy of transcutaneous electrical nerve stimulation in the treatment of a patient with amyotrophic lateral sclerosis due to syringomyelia

Al-Zamil M.K., Kulikova N.G., Vasilieva E.S.

Abstract

This paper demonstrates a clinical case of the development of amyotrophic lateral sclerosis with lesions of the anterior horns of the spinal cord in the cervicothoracic region against the background of syringomyelia.

The main complaints of the patient at the initial request for medical care were associated with weakness and hypotrophy of the right hand. Electrokymography revealed signs of damage to the anterior horns of the spinal cord at the C5–Th1 level with a predominant lesion of the motor fibers of the right median and ulnar nerves. As a result, a diagnosis of amyotrophic lateral sclerosis was made. Magnetic resonance imaging revealed the presence of Chiari I malformation and severe syringomyelia of the cervical and thoracic calving of the spinal cord.

The patient underwent surgical posterior decompression of the foramen magnum. However, the treatment was not effective with the worsening of the neurological deficit in the right hand and the spread of motor deficit and hypotrophy to the left hand.

After the use of transcutaneous electrical neurostimulation of the median and ulnar nerves, there was a significant regression of motor deficit with a decrease in the severity of malnutrition without significant changes in the electromyography parameters of the median and ulnar nerves.

The absence of neurological deficit in the lower extremities, with the preservation of tendon reflexes in the norm, and the absence of pathological reflexes, indicates a high plasticity of the pyramidal tracts at the level of the spinal cord.

Regression of motor deficit after the use of transcutaneous electrical nerve stimulation is due to improvement in the state of altered motor units with hypertrophy of muscle fibers and acceleration of reinnervation processes.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2022;21(2):143-158
pages 143-158 views


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