Vol 18, No 2.1 (2016)

The paper presents the basic concept of the development of medical rehabilitation in the Russian Federation, the main documents regulating the work of medical rehabilitation of the subjects of the Russian Federation, the purpose, objectives, principles, target indicators, separation of powers of public health officials and health care organizations that provide health care. The model of development of medical rehabilitation.

The article is a review of medical support in the rehabilitation process. The main groups of drugs used in rehabilitation: secondary prevention, neuroprotection, treatment of anxiety and depression, spasticity therapy, cognitive impairment, pain, thrombolysis. Multidisciplinary rehabilitation team can increase the effectiveness of drug therapy.

The article is a review of the literature on the role of cognitive impairment (CI) in patients receiving rehabilitation. Cognitive disorders are a common type of problem in patients with different pathologies. The article presents the main causes of CI, discusses the differential diagnosis between CI is impaired function or activity limitation and participation. That is, discussing the possibility of working with CI using the International Classification of Functioning. The article provides rules and guidelines for communicating with patients having CI.

Cervical spinal cord injury (CSCI) is characterized by severe motor and sensory impairments and pelvic organs dysfunction, among which urinary dysfunction (UD) has a special place. The pathogenesis of UD associated with impaired communication between spinal and pontine micturition centers. The article presents the experience of observation of 112 patients with CSCI in the medical center of the III rehabilitation phase. The duration of observation ranged from 3 to 7 years. All patients passed complex urological examination every 1-2 years. Despite of the same level of SCI, clinical picture of urination disorders was different. Neurogenic detrusor overactivity was found in 55 (49.2%) of patients; 46 (41.2%) patients had a detrusor-sphincter dyssynergia with different degrees of voiding dysfunction; 8 (7.1%) patients had voluntary micturition; 3 (2.7%) patients had decreased urinary bladder capacity. The examination included urodynamic study and radiological examination; 83 (74.1%) patients had a stable clinical picture of urination disorders in the first year after the injury. The aim of urological rehabilitation included reduction and prevention of high detrusor pressure, adequate emptying of the bladder by periodic clean intermittent catheterization, prevention and treatment of urinary tract infection. The main criterion for the effectiveness of urological rehabilitation was improvement of quality of life, which was observed in 83% cases. Thereby, patients with cervical spinal cord injury require regular urological rehabilitation, which includes not only correction of urinary dysfunction but also monitoring and prevention of urological complications.

The basic principles of feeding arrangement for patients with neurogenic dysphagia which provide safe and effective intake of food and fluid are discussed: diet modification; thickening of fluids; modification of eating behaviour, including compensatory techniques; artificial accesses for fluid and nutrients delivery.

The most common peripheral vestibular disorders, followed by vertigo, are summarized in the article. The pathophysiologic mechanisms, diagnosis and treatment of benign paroxysmal positional vertigo, Ménière's disease and vestibular neuritis are thoroughly described. Acute management and further rehabilitation procedures in case of these vestibular disorders are analyzed.