The guidelines are devoted to the practical application of the method of remote physical rehabilitation of patients with the new coronavirus infection COVID-19 through telecommunication technologies. The purpose of the document is the need to develop a unified approach in organizing assistance for physical rehabilitation for patients with the new coronavirus infection COVID-19 in military hospitals. The advantage of using telecommunication technologies is associated with a decrease in the risk of personnel infection.
Background. The problem of diabetic angiopathy is characteristic of countries even with a high level of development of medicine. The high frequency of complications of diabetes with high biological and social significance determines the need for their correction. The purpose of the work was to increase the effectiveness of rehabilitation treatment for patients with diabetic angiopathy through the combined use of therapeutic exercises and functional electrical stimulation of the lower extremities. Methods. A prospective cohort study was conducted, in which 90 patients (63 men and 27 women) with an established diagnosis of type 2 diabetes took part. Results. It was found that the use of therapeutic gymnastics and training walking on a treadmill and functional neuroelectrostimulation of the lower extremities increase the motor capabilities of patients due to the analgesic effect, improved neurogenic control of vasoconstriction of arteriovenous anastomoses and increased capillary blood flow. Conclusion. Functional electrical stimulation method can be effectively used in physical therapy programs for patients with diabetic lower limb angiopathies at the inpatient and outpatient stages.
One of the most disabling complications of diabetes mellitus is angiopathy of the lower extremities. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with vascular complications of diabetes mellitus, which significantly aggravate the course of the disease and contribute to high mortality. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with the diabetes mellitus vascular complications that significantly aggravate the course of the disease and contribute to high mortality. Despite the improvement in the results of pharmacotherapy of diabetes mellitus, the problem of treating its vascular complications is far from being solved. Traditionally, therapeutic physical training is used among the methods of non-drug treatment of diabetes mellitus and its complications. As a method of pathogenetic focus on many risk factors for the development of diabetes and its complications, physical therapy exercises contribute to the correction of the syndrome of hypodynamia, obesity, and muscle atrophy. At the same time, there is insufficient data on how exercise therapy affects the quality of life of patients, functional characteristics of walking and objective indicators of blood flow in the lower extremities. This review identifies the main approaches to the application, advantages and disadvantages of individual methods of therapeutic physical training in the correction of functional disorders in patients with lower extremities diabetic angiopathies. We can currently talk about the proven safety of the physical therapy use in patients with diabetic angiopathies. Meanwhile, the scientific data on the high efficiency of this method is still insufficient.
BACKGRAUND: Violation of gait and body balance in patients with diabetic polyneuropathy actualizes the development of new effective measures of motor rehabilitation. In this regard, an observation was carried out in which biofeedback training was used for the reference reaction in the conditions of variable feedback parameters.AIMS: To investigate the effect of a stepwise change in the depth of feedback (sensitivity) in a motor-cognitive task with visual feedback on the reference response to the result of its execution.METHODS: Single-sample observational observation with controlled conditions. 27 patients with diabetic polyneuropathy. All patients were treated according to modern standards. The observation was performed in one series at the beginning of the course of inpatient treatment. Estimation of body balance on a power platform — stabiloplatform) — stabilometry. The procedure included 5 stages of management, in which the patient followed the instructions (training) in which there was a stepwise increase in the depth of feedback («sensitivity») at each stage from 10 to 50% of the conditional «normal», with a step of 10%. A quantitative assessment of the external result (execution of instructions) and parameters of regulation of the vertical posture was carried out.RESULTS: All patients included in the follow-up showed that the implementation of instructions with increasing depth of feedback decreased sharply when the conditionally «normal» value was exceeded by 30–35%. At the same time, the initial parameters of vertical posture control in the sample patients did not affect the dynamics of results when performing the task with visual feedback. Factor analysis indicates the presence of the only significant factor associated with the effectiveness of performing a motor-cognitive task here — changes in the depth of feedback. The accepted significance level α = 0.05.CONCLUSIONS: The depth of feedback in motor-cognitive tasks with visual feedback is a key characteristic that affects performance. The ability to increase the depth of feedback in the range of about 35; from conditionally «normal», can be useful for ensuring differentiation of loads during motor rehabilitation of patients in order to increase the effectiveness of training. In addition, in theoretical terms, the proposed model of the motor-cognitive problem can be relevant in the study of «dual» problems, where the relationship of motor and cognitive components is studied.
Diabetic distal polyneuropathy (DPN) is the main cause of disability in patients with type 2 diabetes mellitus (DM2). The purpose of the research with 72 patients was to study the effect of functional electrical stimulation (FES) on reducing the degree of functional motor disorders in patients with DM2, angiopathy and DPN. Method. The patients were divided into 3 randomized groups (2 main groups, 1 control group). In addition to basic therapy, the patients of the main groups were treated with FES of the lower extremities with a frequency of 10–30 Hz in group 1 and 80–100 Hz in group 2. Results: the dynamics of quantitative assessment of the overall score on the NSS scale after treatment was significantly higher in the main groups compared to group 3 (Mann-Whitney test p 1–3 = 0,001, p 2–3 = 0,006). There was no significant difference in the overall score of the NSS between groups 1 and 2. The most pronounced positive changes in neurofunctional disorders after treatment on the NDS scale were achieved in group 1: the overall score decreased by 52% after the treatment and was significantly lower than in other groups (p 1–2 = 0,014, p 1–3 = 0,002, Mann-Whitney test). According to the treadmill test, tolerance to physical activity increased in all patients after the treatment. Significant positive dynamics of the stabilometric index of the ratio of energy consumption with closed and open eyes while standing on a balancing pillow was observed only in main group 1 (decreased by 41%, p=0,000, Wilcoxon test). Conclusions. The use of FES of the lower extremities as part of complex therapy in patients with DM2 complicated by angiopathy and DPN is safe and allowed reducing the degree of functional disorders and neuropathic complaints to a greater extent in the study group using FES with a frequency of 10–30 Hz.
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