Autism spectrum disorders (ASD) are disorders of psychic development characterized by the difficulties of social interaction and stereotyped and repetitive patterns of behavior. Rather often they are accompanied by disturbances of speech, intelligence, and adaptive behavior. Pathogenesis of ASD is still poorly studied. MRI with its latest modalities is a modern diagnostic method enabling medical providers to evaluate structural, metabolic, and functional features of brain development in this pathology. The aim of the study was to assess the capabilities of functional MRI (fMRI) in determining pathophysiological mechanisms of delay in speech development in ASD. Materials and Methods. A brief review of international studies is given in the article. Our own results of examining 6 preschool children with one of the ASD forms-early childhood autism and speech disorders, and 6 children of the comparison group without autism and language disturbances are also presented using fMRI and a block design paradigm to analyze speech perception patterns. Results. In all children with normal speech development, bilateral symmetric spread of activation along the cortex of the entire superior temporal gyri was revealed whereas children with autism showed lateralized and limited involvement of the auditory cortex. Sevoflurane anesthesia did not influence the character of auditory zone activation. Conclusion. The possibility of using fMRI with application of the paradigm for speech understanding to study the individual features of brain functioning in children with autism has been demonstrated. The revealed objective instrumental signs of brain activity differences in the children with autism compared to the healthy children allow the fMRI data to be considered as a potential biomarker of this disease. It has also been shown that the possibility to carry out this examination under general anesthesia makes it more acceptable and convenient for patients with childhood autism.
Autism spectrum disorders are a group of disorders, the occurrence of which is associated with the impairment of brain development. Typical for them are difficulties in social interaction and communication. Current epidemiological aspects of autistic disorders, methods of their diagnosis and correction as well as risk factors of the disease development are considered in the review. Numerous investigations confirm that timely identification of autistic disorders and child inclusion in the programs of early intervention may be the basis of effective rehabilitation and will be able to improve the prognosis for their socialization. High prevalence of autism spectrum disorders requires active work on designing screening procedures, creating scientifically grounded and standardized normative routing system for this category of patients, and implementing countrywide the programs rendering aid to children with this pathology and their parents.
The purpose of this article is to form the key principles for organizing comprehensive care for people with mental disabilities. The basis for the development of principles was the experience of implementing the public project “Mental Health” in the Volga Federal District. Based on the experience, the main tasks when including the region in the project will be the organization of continuous support from an early age and throughout life, the organization of interdepartmental interaction, the creation of opportunities for the realization of medical, educational, professional, social and other needs of people with mental disabilities. At the same time, the development and approval at the regional level of a road map, which will identify activities, participants in the assistance program, responsible departments and institutions, as well as deadlines, is of particular importance as one of the main stages in the implementation of comprehensive assistance. Using the principles described in the article in its work, the region can quite effectively create a system of comprehensive assistance to people with mental disabilities, having a minimal backlog in this area.
The use of adaptive physical culture in the system of complex rehabilitation of patients with cerebral palsy (CP) is becoming more popular. Adaptive climbing (AC) is one of these types of physical culture and sports activities. Currently, there are not many data in the domestic and world literature devoted to the study of the AC use in the complex rehabilitation of patients with CP. Aim. Evaluation of the effectiveness and safety of AC in the rehabilitation of children and adolescents with spastic forms of CP in addition to conventional medical rehabilitation. Material and methods. The study included 30 patients aged from 5 to 18 years with spastic forms of CP who were allocated into one of two groups: the 1st group, the study group (n=15) — patients who underwent standard medical rehabilitation and AC classes; the 2nd group, the control group (n=15) — participants who received only medical rehabilitation. A comprehensive assessment of the rehabilitation measures effectiveness and safety was performed before the start of AC classes and after 3 months using clinical neurological and instrumental examinations, including biomechanical examination (electropodography, video analysis of walking and stabilography). Results. Group 1 patients showed a statistically significant improvement in general motor functions on the GMFM-88 scale (p=0,0001), a decrease in the level of spasticity on the мodified Ashworth scale (p=0,0051) and an improvement in manual abilities on the MACS scale (p=0,0431) 3 months after inclusion in the study. Positive dynamics in the form of an increase in the symmetry of step time (p=0,0063), step length (p=0,0083) and step velocity (p=0,0409) were noted according to the electropodographic study in the 1st group. A statistically significant increase in the range of motion in the hip (p=0,0038) and knee joints (p=0,0076) was detected in the 1st group according to video analysis of walking. There was no significant change in the indicators in the 2nd group, except for the severity of spasticity on the modified Ashworth scale (p=0,0180). A positive correlation was found between the indicators “step length” and “ step velocity” (r=0,605, p=0,0168). A negative correlation was found between the “step velocity “ indicator and the GMFCS score (r= – 0.832, p=0,0372). Only 2 adverse events were registered in the study group: acute respiratory viral infection and wrist injury during AC. Conclusion. AC, in addition to traditional methods of medical rehabilitation, leads to a decrease in spasticity, increased joint mobility and control of voluntary movements, improved maintenance of the body position, walking and precise hand movements, and also has a favorable safety profile. AC is an effective and safe motivating method of physical culture that can change the patient’s view on traditional therapy.
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