The expert consensus of the Russian communities discusses the issues of comprehensive medical rehabilitation of patients with coronavirus disease 2019 (COVID-19). COVID-19 is a contagious infectious disease that can cause pulmonary, cardiac, motor, metabolic, neurocognitive and mental disorders, that is, multiple organ dysfunction. COVID-19 survivors, especially after a severe clinical course, face serious psychological and physical problems, posttraumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the COVID-19 severity, have a long clinical course of the disease (“chronic-COVID”, “long COVID”). There is evidence of post-acute COVID-19 syndrome. In this regard, patients after COVID-19 will need rehabilitation measures. The expert consensus of the Russian communities presents general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The paper includes recommendations on comprehensive cardiac and pulmonary rehabilitation, as well as specifics of rehabilitation care for different COVID-19 courses within the national three-stage rehabilitation system.
In 40 patients with patellofemoral pain syndrome, before and after the course of treatment, the strength indices of the hip muscles were studied by isokinetic dynamometry, as well as the severity of the pain syndrome in the knee joint and the lumbosacral spine according to the visual analogue scale. The patients of the main group (n = 20) used the technique of complex correction of the pelvic region and lower limb, which was mainly aimed at stabilizing the lumbosacral spine. Patients of the control group (n = 20) performed therapeutic gymnastics aimed at training the muscles of only the interested lower limb. The treatment was performed on an outpatient basis daily for 21 days. After the course of treatment in patients of the main group, the strengths of the quadriceps femoris were significantly higher (p < 0.05), and the degree of pain in the knee joint and lumbar spine was significantly lower (p < 0.05). The obtained data confirm the necessity and expediency of including exercises for stabilization of the lumbosacral spine in the rehabilitation program for patients with patellofemoral pain syndrome.
Abstract:In chronic stage of stroke, it is necessary to pay attention to the complex spatial movements training along with the traditional restoration of balance, strength of particular muscles, and paretic limb joints mobility. The aim of the study was to evaluate the effectiveness of robotic therapy in the recovery of upper limb function in the chronic stage of stroke. The study involved 52 patients with ischemic stroke in the middle cerebral artery. The patients were divided randomly into 2 groups. All patients (5 days/wk × 3 wk) got gymnastics by the standard technique, massage, laser, and pulsed currents therapy. Main group patients (n = 36) extra received complex spatial movements, speed, fluidity, precision and agility training by the robotic electromechanical device Multi Joint System (MJS) (40 minutes, 5 days/wk × 3 wk). Analysis of the results of the study showed a statistically significant difference in improving ROM of the elbow and shoulder joints, speed and accuracy of movement in the main group compared with the control. Hardware recovery of complex spatial upper limb movements in the chronic stage of stroke increases the functionality and independence of the patient's domestic skills.
BACKGROUND: Over the past years, injuries have been consistently included in the first seven leading classes in the structure of general morbidity, and in the distribution of the number of people aged 18 years and over who were first recognized as disabled, they are included in the first six causes of disability.
AIM: to study the clinical efficacy and safety of the author's technique, in patients after injuries of the lower and upper extremities at the second stage of medical rehabilitation.
MATERIALS AND METHODS: The study included 105 patients who had suffered injuries. 37 (35.2%) men, 68 (64.8%) women. The patients were randomly divided into 2 observation groups: the main group (n=53), whose patients, in addition to the standard rehabilitation program, were trained on the biofeedback simulator Tergumed Pegasus 3D (Germany), a course of 710 procedures, and the control group (n=52), whose patients underwent a course of medical rehabilitation only according to the standard program of the 2nd stage, lasting 1014 days. The complex rehabilitation treatment of patients included standard drug therapy, massage courses, physiotherapy, group exercise therapy. Treatment outcomes were assessed using the VAS (Visual Analog Scale), HAQ (Health Assessment Questionnaire), Lequesne index, and 20-m walking time scales. Data analysis included comparison of dependent series of variables and descriptive statistics methods. The type of data distribution (parametric or nonparametric) was assessed using the ShapiroWilk and KolmogorovSmirnov tests. The statistical significance of differences between dependent groups was assessed using the Wilcoxon and MannWhitney tests. The value of p=0.05 was taken as the level of statistical significance.
RESULTS: All measured indicators improved significantly (p 0.001). In the main group, compared with the control group, there was a statistically significant increase in walking speed, and there was a tendency to a more pronounced positive change in the Lequesne and HAQ indices, the level of pain according to VAS, compared with the control group.
CONCLUSION: Our proposed method of training with the participation of antigravity muscles trunk is effective for patients after limb injuries at the 2nd stage of medical rehabilitation.
In the Consensus of experts from Russian societies, issues of comprehensive medical rehabilitation of patients with a new coronavirus infection are being discussed. Coronavirus Disease 2019 (COVID-19) is a contagious infectious disease that can cause respiratory, cardiac, motor, metabolic, neurocognitive and mental disorders, i.e. multiple organ dysfunction. Patients who survived COVID-19, especially after a severe course, face serious psychological and physical problems, post-traumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the severity of the coronavirus infection, have a long-term course of disease ("chronic COVID", "long-term COVID"). There is evidence of the development of "post-COVID-19 syndrome". In this regard, patients with COVID-19 need rehabilitation. The Consensus of experts from Russian societies provides general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The Consensus includes recommendations on comprehensive cardiac and respiratory rehabilitation, as well as the features of the rehabilitation of patients with different clinical course of COVID-19 within the framework of the national three-stage medical rehabilitation system.
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