Current issues of disability and rehabilitation of elderly and senile patients with lower limb loss due to vascular pathology

Большинство пациентов с ампутационным дефектом нижних конечностей являются гражданами пожилого возраста с высокой ко- и полиморбидностью, наличием нескольких гериатрических синдромов, что неблагоприятно влияет на прогноз, снижает реабилитационный потенциал, в ряде случаев приводит к развитию сердечно-сосудистых осложнений, ампутации второй конечности, тяжелой инвалидизации и высокой послеоперационной летальности. Ключевым звеном процесса реабилитации инвалидов с культей нижней конечности является обеспечение их функциональным протезом. В статье приведен анализ заболеваемости, первичной инвалидности в период 2015-2019 гг., гендерных, возрастных и клинических характеристик пациентов, проживающих в Санкт-Петербурге, которым выполнена ампутация нижней конечности вследствие сосудистой патологии. Установлено, что отсутствует информация о выживаемости пациентов после проведения ампутации в различные сроки постгоспитального периода в Санкт-Петербурге. Выявлен выраженный дисбаланс между количеством выполняемых ампутаций нижних конечностей ежегодно и количеством обращений инвалидов в бюро медико-социальной экспертизы для обеспечения техническими средствами реабилитации и направлением на первичное протезирование, реабилитацию. The majority of patients with amputation defect of the lower extremities are elderly citizens with high co- and polymorbidity, the presence of several geriatric syndromes, which adversely affects the prognosis, reduces the rehabilitation potential, in some cases leads to the development of cardiovascular complications, amputation of the second limb, severe disability and high postoperative mortality. The key link in the rehabilitation process of disabled people with a lower limb stump is to provide them with a functional prosthesis. The article provides an analysis of morbidity, primary disability in the period from 2015 to 2019, gender, age and clinical characteristics of patients living in St. Petersburg who underwent amputation of the lower limb due to obliterating artery diseases is presented. It was found that there is no information on the survival rate of patients after amputation at various times of the post-hospital period in St. Petersburg. We have identified a pronounced imbalance between the number of lower limb amputations performed and the number of applications of disabled people to the bureau of medical and social expertise for providing technical means of rehabilitation and referral to primary prosthetics.

Medical rehabilitation and infectious diseases in children

Today, medical rehabilitation is undergoing significant transformation. The new system built around the biopsychosocial model includes assessment of physical constraints and rehabilitation diagnosis, determination of rehabilitation potential, formulation of goals and objectives of individual interventions, development of rehabilitation plans, and progress evaluation. All of these rehabilitation components can be implemented using a personalized, problem-oriented, multidisciplinary approach, which is now being actively introduced into clinical practice. The current pandemic of the novel coronavirus infection has demonstrated that medical rehabilitation is crucial for convalescents. However, its principles and techniques have not been fully elaborated yet. This review describes the current state of medical rehabilitation of children with or after infectious diseases and identifies its avenues and prospects.

Rehabilitation potential in older people living with frailty: a systematic mapping review

Background Following periods of acute ill-health and injury, older people are frequently assessed and provided with rehabilitation services. Healthcare practitioners are required to make nuanced decisions about which patients are likely to benefit from and respond to rehabilitation. The clinical currency in which these decisions are transacted is through the term “rehabilitation potential”. The aim of this study was to explore information about rehabilitation potential in older people to inform the development of an evidence-based assessment tool. Methods A systematic mapping review was completed to describe the extent of research and the concepts underpinning rehabilitation potential. We searched Medline, CINHAL, EMBASE, AMED, PsycINFO, PEDro, Cochrane Library, Web of Science, ProQuest, Trip and EThOS from inception to December 2020. We included studies which focused on rehabilitation potential and/or assessing for rehabilitation interventions for older people with comorbidities in the hospital and community setting. Reviewer pairs independently screened articles and extracted data against the inclusion criteria. A descriptive narrative approach to analysis was taken. Results 13,484 papers were identified and 49 included in the review. Rehabilitation potential was found to encompass two different but interrelated concepts of prognostication and outcome measurement. 1. Rehabilitation potential for prognostication involved the prediction of what could be achieved in programmes of rehabilitation. 2. Rehabilitation potential as an outcome measure retrospectively considered what had been achieved as a result of rehabilitation interventions. Assessments of rehabilitation potential included key domains which were largely assessed by members of the multi-disciplinary team at single time points. Limited evidence was identified which specifically considered rehabilitation potential amongst older people living with frailty. Conclusions Current approaches to rehabilitation potential provide a snapshot of an individual’s abilities and conditions which fail to capture the dynamic nature and fluctuations associated with frailty and rehabilitation. New approaches to measures and abilities over time are required which allow for the prognostication of outcomes and potential benefits of rehabilitation interventions for older people living with frailty.

THERAPEUTIC EFFECT OF SINGLET OXYGEN ADMINISTRATION ON CRYSTALLIZATION OF RATS’ BLOOD SERUM AT THERMAL TRAUMA

Biological and therapeutic effects of singlet oxygen have not been investigated yet. The aim of this paper is to estimate the influence of a short course (10 days) of singlet oxygen inhalations on crystallogenic properties of rats’ blood serum. The experiment was performed on 30 male Wistar rats, randomly divided into three equal groups. The first group was intact. The animals of the 2nd (control) and 3rd (test) groups under combined anesthesia were subjected to thermal trauma. Starting from the day following the injury, the rats of the test group inhaled daily the air flow from a singlet oxygen generator during 10 days. Blood samples were obtained from the rats of all groups. Dried samples were evaluated visually for crystallizability, structure index, facia destruction degree, and marginal zone clarity, using respective scales. It is stated that singlet oxygen inhalations facilitate the elimination of negative transformations in blood crystallization induced by thermal trauma. It indicates the positive rehabilitation potential.

ANALYSIS OF THE AVAILABILITY AND EFFICIENCY OF MEDICAL CARE PROVIDED TO PATIENTS IN THE PROFILE "MEDICAL REHABILITATION" IN ASTRAKHAN REGION

The relevance of the study due to the need to pay more attention to the effective planning of health care volumes under the compulsory health insurance and the creation of an accessible system of medical rehabilitation for adults in the region. The purpose of the study is to analyze the availability and effectiveness of medical care provided to adults in the "medical rehabilitation" profile within the framework of compulsory medical insurance in the Astrakhan region. Materials and methods - on the basis of data from the Federal State Statistics Service, the territorial fund of compulsory medical insurance in the Astrakhan region, annual reporting statistical forms No. 30, 14, 14-DS, the calculation and analysis of indicators of the optimal volume of medical care for the profile of medical rehabilitation was carried out, taking into account the profile of the disease (the number of hospitalizations per one inhabitant per year, funding per unit of the volume of medical care) of adult patients aged 18 years and older. Results and discussion - the article presents the results of assessing the planned and actual indicators of the volume of medical care for medical rehabilitation for adults, taking into account the profile of diseases in the conditions of round-the-clock and day hospitals of medical organizations participating in the territorial program of state guarantees of free provision of medical care to citizens in the region in 2019. It was revealed that at the expense of the compulsory medical insurance fund, the largest proportion of treated patients in rehabilitation beds is noted among those who receive medical services for neuro- and cardiac rehabilitation. However, rehabilitation care for critically ill patients with scores on the rehabilitation routing scale of 5 and 6 points, with a high rehabilitation potential, as well as for other categories of patients with somatic diseases, remains inaccessible. Conclusion. The obtained research data can be used for further organizational and methodological work to increase the availability and efficiency of medical rehabilitation care for adults, the development of available routing schemes, selection procedures, digitalization of the management of patient flows sent to medical rehabilitation within the framework of compulsory medical insurance at the regional level.

Traumatic brain injury and coping processes – improving outcomes by involving family in the rehabilitation process

Following a traumatic brain injury, many patients struggle to cope with daily activities and experiences, both at the physical and psychological level. In addition to the patient's own coping process, the family's involvement in the heal-ing process is extremely important. Acute care is usually provided by family members and has the potential to either support or hinder rehabilitation and adaptation processes. In addition to new limits of self-care and complaints caused by brain damage, patients face far-reaching psychosocial problems. Despite increasing interest in the management of brain damage and processing of the disease, there is a lack of health-promoting concepts designed to address the impairments and psychosocial relationship difficul-ties suffered by people after traumatic brain injury. In this study, rehabilitation potential was identified by analyzing the results of biographical narrative interviews with men who had suffered a traumatic brain injury in an industrial accident, and their relatives. The selection and qualitative analysis of the rehabilitation process of traumatic brain injury patients reveals the potential for intervention and the need for a holistic integration process between the patient, relatives and physicians, which can be further supported by integrating family members into the treatment process. Keywords: rehabilitation of traumatic brain injury, qualitative social research, reintegration, relatives

Possibilities of diff usion-weighted magnetic resonance imaging in determining the rehabilitation potential of the acute period of ischemic stroke

Studies over the past decade demonstrate the high potential of diff usion-weighted MRI (dMRI) as a modern technique for non-invasive quantitative assessment of the microstructural integrity of the white matter of the brain, which allows predicting some aspects of the rehabilitation potential. Purpose of the study: to calculate the threshold values of fractional anisotropy (FA) of some cerebral tracts, which are informative in determining various aspects of the rehabilitation potential in the acute period of ischemic stroke. Patients and methods. We examined 100 patients with ischemic stroke and 10 persons without stroke and cognitive impairment. All patients underwent dMRI and clinical assessment of indicators of rehabilitation potential at discharge. Results. The NIHSS at discharge is associated with the size of infarction, the FA of the anterior, posterior leg and knee of the internal capsule, the superior longitudinal, cingular and inferior fronto-occipital bundles. Similar associations were noted for the Rivermead mobility index and the Rankin scale. The function of the hand according to the Frenchay scale is associated with the size of the lesion, FA of the anterior leg of the internal capsule, superior longitudinal, inferior fronto-occipital and cingular bundles. The MoCA is interrelated only with the size of the infarction and the FA of the anterior leg of the internal capsule, the Berg scale — with the size of the lesion and the FA of the upper longitudinal bundle, the FIM scale — with the FA of the upper longitudinal, inferior fronto-occipital and cingular bundles. The threshold values of FA of the cerebral tracts which are most informative in determining various aspects of the rehabilitation potential in the acute period of ischemic stroke were determined. Conclusion. The quantitative assessment of the FA of the main projection and associative tracts is informative in relation to the determination of the rehabilitation potential in the acute period of ischemic stroke.