Vol 19, No 2-1 (2017)

This article is devoted to the description of a universal tool for assessment the independence, disability of patients and the need for external assistance for medical rehabilitation. The Rankin scale is valid for assessing patients of any profile, regardless of pathology. In the article the rules of estimation according to the Rankin scale are given, the features of the evaluation on the scale at different stages of rehabilitation and under different pathologies are analyzed. The authors emphasize that the scale is universal since it does not focus on individual types of pathology and symptoms, but rather assesses the patient's possibilities for self-care and movement, and also the need for help from other people in everyday life.

The article showed the importance of applying the cholinergic drugs in the treatment of patients in an early recovery period of the stroke. The purpose of the study was to evaluate the efficacy of the drug ipidacrine in complex therapy of patients in the early recovery period of ischemic stroke with moderate motor and cognitive disorders. Materials and methods. 62 patients in the early recovery period of stroke were enrolled; (mean age 62.34±5.7 years). The main group included 32 patients with stroke which along with the standard treatment regimen, received ipidacrine 20 mg 1 tablet 3 times a day for a month. The control group consisted of 30 patients with stroke receiving standard treatment regimen. We assessed the dynamics of the neurologic status of patients, scales and questionnaires. Results and conclusion. The study demonstrated high efficacy of ipidacrine in the treatment of patients in the early recovery period of stroke: reliable improvement of motive and cognitive functions, emotional violations, reduction of expressiveness of a pain syndrome is shown.

The rehabilitation of patients with spastic paralysis of upper extremities is very important. It explains the high incidence of diseases and complication of spasticity. It leads to the formation of specific limb deformities and dysfunctions. If patient doesn’t have any correct rehabilitation or it absence, neurological dysfunctions leads to orthopedic disorders. The modern approach to the rehabilitation of such patients includes close interdisciplinary interaction. Despite this, a superficial analysis of the published data showed extremely rare participation in orthopedist in multidisciplinary teams. That is why we lose orthopedic problems of deformation because of spasticity. Distal surgery allows to potentiate the effect of conservative methods of rehabilitation medicine, and in some cases is way to overcome a plateau rehabilitation. However, for the formation of the indications for surgical treatment requires adequate assessment of the musculoskeletal system, the degree of patient adaptation and rehabilitation potential, which was not revealed in the analysis of patient’s histories. Initiate closer interdisciplinary interaction with involvement in the healing process of all the necessary specialists, including orthopedic and reconstructive surgeons, will implement joint inspections and consistent filling of standardized cards containing evaluative characteristics presented in categories of the International Classification of Functioning, relevant to all interested professionals. The optimal content of maps, data would be to characterize the patient from the standpoint of the ICF.

Recovering gait skills is one of the most important tasks of rehabilitation of post-stroke patients. In recent years robotic devices have been used extensively in physical rehabilitation for the gait recovery. The article presents the results of the study of efficiency of using robotic kinesiotherapy in complex rehabilitation of patients after stroke. There were organized medical examinations of 50 patients, including 50 in the main group with the use of the robotic complex ‘Locomat’ and 42 patient in control group with the use of conventional physical therapy. As a result, there are statistical differences in regard to the indices of mobility, motor skills and sensitivity in paretic limb, strength and muscle tone in paretic limbs, as well as the overall improvement of daily activity. It has been determined that the use of robotic devices has positive impact in rehabilitation of post-stroke patients.

Aphasia (loss of language abilities following focal brain damage) creates communication barriers and can dramatically affect the quality of life. Social activity and quality of life of individuals with aphasia may be particularly negatively affected by the society being poorly informed and thus not able to integrate them. Additionally, rehabilitation outcomes are highly dependent on aphasia awareness of patients’ caregivers. We conducted a survey of clinicians to gauge the current level of public awareness of aphasia in Russia. This paper outlines the survey results and suggests ways to increase public awareness of aphasia and of the crucial role of speech-language pathologists in neurorehabilitation.

Article is devoted to the review of the modern foreign and domestic publications devoted to a problem of cognitive impairments in case of the traumatic brain injury (TBI) including questions of a definition and classification of TBI, frequency and the nature of cognitive, behavioral and emotional disorders in case of a brain injury, the sequence of restoration of cognitive functions, to approaches to treatment and rehabilitation of cognitive impairments. Questions of drug treatment of cognitive impairments, and also the analysis of the known techniques of rehabilitation, including personal, group occupations, the computerized technologies of recovery training are considered.

Cerebral stroke continues to be an important medical and social problem. Often it is accompanied by depression, which, due to the reduction of initiative and motivation of patients, prevents their active participation in the rehabilitation activities. The purpose of this research is to study the effectiveness of the inclusion of dynamic electroneurostimulation (DENS) in the rehabilitation of persons in the acute period of ischemic stroke for the correction of psychoemotional disorders, such as post-stroke depression, anxiety and low level of motivation. Materials and methods. A total of 47 patients (24 men and 23 women, mean age 64.4±2.2 years) with acute ischemic stroke has been examined. A psychological and psychometric study in dynamics has been held (in accordance with BDI scores, Spielberger test, questionnaire “The motivation for success and motivation for fear of failure” - A.Rean's questionnaire). Clinical evaluation of neurological status was supplemented by scoring the neurological deficit on Lindmark scale. In addition to medical treatment, DENS therapy has been carried out for 15 days. Monitoring of the status of the control group of patients (36 people), corresponding to the study group by sex, age and severity of neurological symptoms, was conducted simultaneously. Patients in this group received only standard therapy. Results. The severity of depression and anxiety in the main group significantly decreased (by 4.0 points on Beck scale, and 8.6 points on Spielberger scale), while in the control group significant differences in indices were not detected (1.6 and 3.0 points, respectively). A.Rean's questionnaire analysis showed that during treatment, motivation level in the study group increased significantly, and the patients were oriented to success. While in the control group, significant changes in the level of motivation did not happened. Conclusion. Thus, the study showed that DENS is effective for the treatment of depression and anxiety among patients with ischemic stroke, and contributes to higher motivation of these patients.

Endothelial dysfunction is considered as a common link in the pathogenesis of anxiety and depressive disorders and cardiovascular diseases. The broad spectrum of biologically active substances is represented by the laboratory markers of endothelial dysfunction that applied for diagnostics of endothelial impairment. Pharmacotherapy of endothelial dysfunction allows optimizing management and improve prognosis of patients with cardiovascular diseases and affective disorders.

Complaints of dizziness and imbalance are often found in elderly patients. The age features of the vestibular receptors of the labyrinth and vestibular centers of the central nervous system are presented, as well as the visual and proprioceptive systems involved in maintaining equilibrium. The authors cite the algorithm for clinical examination of an elderly patient with dizziness using both simple tests and complex diagnostic equipment. The most frequently observed vestibulopathies, the features of their diagnosis and the principles of rehabilitation in old age are considered.

In work are provided job analysis of neurorehabilitation department of sanatorium "Zelenaya roshcha" (the III stage of rehabilitation) for 2011-2015. Positive dynamics in the form of growth of improvement of sanatorium treatment at patients with acute violation of cerebral circulation in early and late the recovery periods is noted: from 97.4% in 2011 to 98.9% in 2015. Implementation of the III stage of rehabilitation (sanatorium treatment) of patients after rendering specialized, including high-technology medical care that will allow to increase efficiency of programs of rehabilitation of patients, will reduce by 1.5-2.1 times the morbidity and mortality among patients with stroke and a positive impact on their health status and to improve the quality of life of the patients.