Modern technologies of medical rehabilitation of children with chronic constipation

Medical rehabilitation of children with chronic constipation is a complex system of measures, including: rational nutrition, drug therapy, physiotherapy, physical therapy, massage, et. The main tasks of medical rehabilitation are: normalization of the passage of fecal masses, tone of the sphincter apparatus of the rectum and pelvic floor muscles, restoration of the defecation reflex and reduction of astheno-vegetative disorders. The article describes the methods of physiotherapy used in the treatment of chronic constipation in combination with diet, daily routine, medication, physical therapy and massage: amplipulstherapy, interference therapy, percutaneous electroneurostimulation, high-intensity magnetic therapy, transcranial electrostimulation. Balneotherapy methods are widely used: internal and external application of mineral waters, as well as heat treatment and peloid therapy. Natural and artificial physical factors are assigned differentially, taking into account the type of intestinal motility disorders. One of the promising areas of modern physiotherapy is the study of the combined and combined use of two physical factors that increase the effectiveness of the program of medical rehabilitation of children with chronic constipation. Methods of medical and psychological correction are of great importance in the medical rehabilitation of children with chronic constipation.

Experience of Outpatient Rehabilitation of Patients after Pneumonia Associated with the New Coronavirus Infection COVID-19

The revealed functional disorders in patients who have suffered pneumonia associated with the new coronavirus infection COVID-19 require long-term rehabilitation, in particular in outpatient environment. Aim. To evaluate the effectiveness of outpatient rehabilitation of patients who have suffered pneumonia associated with the new coronavirus infection COVID-19. Material and methods. The study included 72 patients after mild to moderate pneumonia associated with the new coronavirus infection COVID-19. The main group included 37 patients who underwent comprehensive rehabilitation, including physical therapy, massage, magnetic therapy, speleotherapy, cognitive behavioral therapy, and drug therapy. The comparison group (35 patients) received physical therapy, magnetic therapy and drug therapy. The effectiveness of therapy was assessed on the basis of standardized questionnaires and scales: Asthenia scale (MFI-20), Anxiety and Depression scale (HADS), mMRC and Borg dyspnea scales, clinical and laboratory examination data. The quality of life of patients in the dynamics of rehabilitation was assessed by the quality of life questionnaire (EQ-5D). Results and discussion. In the main group of patients, the effectiveness of rehabilitation was higher relative to the decrease in the severity of dyspnea, asthenia, normalization of lymphocyte levels. In this group, the quality of life improved more significantly on the scales of anxiety/depression and psychoemotional status. Conclusion. The rehabilitation program, which additionally included chest massage, speleotherapy, transcranial electrical stimulation (TES), showed an advantage in improving clinical and laboratory parameters and quality of life in patients who have suffered pneumonia associated with the new coronavirus infection COVID-19.

Therapeutic Effect of Magnetic Stimulation Therapy on Pelvic Floor Muscle Dysfunction

Pelvic bottom dysfunction includes sexual dysfunction, lower urinary tract dysfunction, defecation dysfunction, etc., and the quality of daily life is significantly impaired. Although drug based and surgical therapies exist as treatment methods, non-invasive treatment methods for pelvic floor dysfunction are highly desired, and magnetic stimulation therapy is attracting attention as a potential new approach. Magnetic stimulation therapy can generate deeper stimulations as compared to electrical stimulation therapy, is less painful, and can be performed while wearing clothes. In addition, it is a very safe treatment method with only few reports of side effects. From nocturnal enuresis in children to middle-aged sexual dysfunction and urinary incontinence in the elderly, therapeutic effects on various pelvic floor dysfunctions have been confirmed regardless of age and gender. It is expected that magnetic therapy will continue to develop as a new therapy in the futures. This chapter first describes the pelvic floor muscles and the principles of anatomy and magnetic therapy. In addition, the therapeutic effects of magnetic therapy will be explained in detail one by one. We will also explain the potential application of magnetic therapy for sarcopenia, which is a problem in our aging society.

Еndothelial dysfunction in patients with chronic obstructive pulmonary disease: feasibility of non-medicamental treatment (literature review and personal experience)

The aim of the work was to study the feasibility of the use of non-medicamental factors for the correction of endothelial dysfunction in patients with chronic obstructive pulmonary disease. Results. Chronic obstructive pulmonary disease (COPD) is considered as a systemic disease, one of the pathogenetic components of which is endothelial dysfunction (ED), which contributes to the development of comorbid cardiovascular pathology. At the same time, the basic treatment of patients with COPD includes drugs that may adversely influence it, and some medicines for the cardiac pathology treatment can increase the bronchial obstruction. Therefore, a question of non-medicamental methods of ED correction is actual, especially beyond the acute period of the disease. Methods of hardware physiotherapy, including ozone therapy, singlet oxygen therapy and its combination with magnetic therapy, low-intensity laser radiation, ultrasound therapy, a combination of laser therapy with balneotherapy, are widely employed. These methods have antioxidant, bronchodilating and anti-inflammatory effects, promote improvement of hemodynamics, as well as rheological properties of blood and microcirculation. Interval hypoxic therapy is also used, because in response to the hypoxic stimulation, the mechanisms of the respiratory system regulation, gas exchange and blood circulation are activated. It is also promising to use haloaerosoltherapy (HAT), which due to the increase of bronchs drainage function and sanitizing effect leads to the inhibition of local inflammation, improves ventilation and gas exchange, and reduces the intensity of oxidative stress, which promotes decrease of systemic inflammation and ED, associated with it. Particularly, this effect is manifested by lowering of edothelin-1 level and the expression of adhesion molecules by lymphocytes (CD54+). Conclusions. The analysis shows that the inclusion of methods with non-medicamental influence on the endothelium can significantly increase the effectiveness of complex treatment of patients with COPD, without increasing the medicinal load on the organism, which helps to avoid undesirable side effects. The use of HAT in the rehabilitation treatment of COPD patients contributes not only to decreasing the activity of local and systemic inflammatory processes, but also is accompanied by a certain correction of ED. However, specific recommendations for the use of certain non-medicamental effects in the complex rehabilitation treatment of patients with COPD, taking into account the presence of ED, have not been developed.

COMPARISON BETWEEN KINESITHERAPY, MAGNETIC FIELD AND THEIR COMBINATION FOR CEREBRAL MOTOR DISORDERS IN EARLY CHILDHOOD

Introduction:- There are no comparative studies between kinesitherapy, magnetic field, and their combination for cerebral motor disorders in early childhood. There is a consensus on the short-term but not on the long-term efficiency of magnetotherapy. There is a consensus on kinesitherapy but not on its optimal frequency. Aim: The first purpose of the study is to compare the short and long-term effects of kinesitherapy, magnetic field, and their combination for cerebral motor disorders in early childhood. The second purpose was to determine the optimal frequency of kinesitherapy. Material and methods:- Seventy-four children (age 6.91 ± 4.78 m corrected age 6.40 ± 5.08 m) with cerebral motor disorders participated in the study. The followed-up periods were two weeks and six months. Four of the groups were physiotherapeutic. One group was the control. The control group, consisting of 15 children, received once-daily placebo magnetic therapy for two weeks. The magnetotherapy group, including 14 children, received once-daily magnetotherapy for two weeks. The kinesitherapy group consisted of 18 children. They received once-daily kinesitherapy. The group with kinesitherapy + placebo magnetic therapy included 15 children. They received once-daily placebo magnetic therapy and once-daily kinesitherapy for two weeks. The combined group (kinesitherapy with magnetotherapy) consisted of 15 children. They received once-daily magnetic therapy and kinesitherapy for two weeks. The groups with kinesitherapy received instructions to perform it as often as possible at home. The following factors were registered and analyzed: pathological and primitive reflexes, kinesiology tests, cranial ultrasound, and frequency of kinesitherapy. Results:- At the beginning of the follow-up, there was no difference between the five groups regarding all factors (P>0.05). The combined group with kinesitherapy and magnetic field showed the best results at the end of the second week and the sixth month (P<0.05). The group with kinesitherapy and placebo magnetic therapy showed the second-best results (P<0.05). The results of the kinesitherapy group were worst than the previous groups but better than the control group (P<0.05). At a frequency of kinesitherapy twice daily, the binary index of kinesiology tests was 0.102, primitive reflexes - 0.308, and cranial ultrasound - 0.487. At a frequency of kinesitherapy three times daily, the binary index of kinesiology tests was 0.833, primitive reflexes - 0.955, and cranial ultrasound - 0.651. Conclusion:- Cranial ultrasound revealed relatively stationary morphological changes. However, the developing nervous system in cerebral motor disorders at early childhood showed significant positive dynamics and plasticity, verified by kinesiology tests, primitive and pathological reflexes. The best results showed the combined group with kinesitherapy and magnetic field. The effects of kinesitherapy and magnetic field upgraded over each other. Twice daily frequency of kinesitherapy achieved insignificant effectiveness, while three times daily - significant. The recommendation for cerebral motor disorders in early childhood to perform kinesitherapy at least three times daily is very important.

The Effect of Virtual Reality Training on Anticipatory Postural Adjustments in Patients with Chronic Nonspecific Low Back Pain: A Preliminary Study

Objectives. This study is aimed at exploring the effects of virtual reality (VR) training on postural control, measured by anticipatory and compensatory postural adjustments (APAs and CPAs, respectively), in patients with chronic nonspecific low back pain (CNLBP) and the potential neuromuscular mechanism of VR training. Methods. Thirty-four patients were recruited and randomly assigned to the VR group ( n = 11 ), the motor control exercise group (MCE, n = 12 ) and the control group (CG, n = 11 ). The VR group received VR training using Kinect Xbox 360 systems and magnetic therapy. Besides magnetic therapy, the participants in the MCE group performed real-time ultrasound-guided abdominal drawing-in maneuver (ADIM) and four-point kneeling exercise. The CG only received magnetic therapy. Surface muscle electromyography (sEMG) was used to record the muscle activities of transverse abdominis (TrA), multifidus (MF), lateral gastrocnemius (LG), and tibialis anterior (TA) during ball-hitting tasks. The muscle activation time and integrals of the electromyography activities (IEMGs) during the APA and CPA stages were calculated and used in the data analysis. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) scores were also recorded. Results. A significant interaction effect of time × group was observed on the activation time of TrA ( p = 0.018 ) and MF ( p = 0.037 ). The post-intervention activation time of the TrA was earlier in the VR group ( p = 0.029 ). In contrast, the post-intervention activation time of the MF was significantly delayed in the VR group ( p = 0.001 ). The IEMGs of TrA ( p = 0.002 ) and TA ( p = 0.007 ) during CPA1 significantly decreased only in the VR group after the intervention. The VAS scores of three group participants showed significant decreases after intervention ( p < 0.001 ). Conclusions. Patients with CNLBP showed reciprocal muscle activation patterns of the TrA and MF muscles after VR training. VR training may be a potential intervention for enhancing the APAs of the patients with CNLBP.

Possibilities of non-invasive neuromodulation in rehabilitation

This article describes the physical basis and clinical capabilities of various non-invasive neuromodulatory techniques in the rehabilitation of patients. Neuromodulatory techniques can improve the patient’s recovery by influencing the processes of neuroplasticity. Modern non-invasive neuromodulation includes TES therapy, magnetic therapy, TCMP, EHF therapy, as well as one of the most promising methods — rhythmic transcranial magnetic stimulation (rTMS). It is assumed that TMS has a modulating effect on the regulation of the functions of the autonomic nervous system, cerebral vascular reactivity, activity of the immune system, in addition to affecting the electrophysiological parameters of neurons, also affects the facilitation of sprinting, neurogenesis. In addition, TMS causes inhibition in nociceptive trigeminothalamic neurons. The methods of non-invasive modulation of neuroplasticity are based on neurophysiological processes of activation and inhibition in the central and peripheral nervous system, as well as the possibility of their regulation by various components of electromagnetic effects. Non-invasive methods of neuromodulation can be combined with other methods of therapy (drug, physiotherapy, reflexology, massage, manual therapy, etc.). Features of non-invasive neuromodulation methods, their safety and ease of use allow for differentiated use in the clinic of rehabilitation treatment and become an important component of active drug and non-drug rehabilitation of patients. Key words neuroplasticity, non-invasive neuromodulation; non-drug rehabilitation, transcranial magnetic stimulation

Evaluation of the effectiveness of low-frequency magnetotherapy in the rehabilitation of patients with pneumonia caused by the SARS-CoV-2 virus (the causative agent of COVID-19)

The study aimed to evaluate the effectiveness of the low-frequency magnetic therapy with a "running" magnetic field in medical rehabilitation after COVID-19 pneumonia. Materials and research methods: The study included 42 patients (24 men and 18 women) aged 40 to 65 years, who had pneumonia (J16.8) caused by the new coronavirus SARS-CoV-2. The first group included 22 patients who received standard drug therapy and starting from the 20th day after discharge from the hospital, this group of patients received low-frequency magnetotherapy with a “running” pulsed magnetic field of the ALMAG-02 apparatus. The second group included 20 patients who received the same treatment, except for magnetotherapy. Results: The course of rehabilitation measures carried out led to an increase in the functional capabilities of the cardio-respiratory system in patients of both groups, an increase in chest excursions, an increase in the vital capacity of the lungs, the normalization of the act of breathing and ventilation of the lungs, and an improvement in the psychosomatic status of patients. In the main group, these changes are more pronounced than in the control group, which is associated with the inclusion in the complex treatment of low-frequency magnetotherapy with a “running” pulsed magnetic field. Conclusion: The use of low-frequency magnetic therapy with a "running" pulsed magnetic field in the complex of rehabilitation measures for patients who have suffered from COVID-19 pneumonia significantly improves the somatic status of patients, increases exercise tolerance, and optimizes the function of external respiration. Keywords: magnetotherapy, COVID-19, pneumonia