По данным национального регистра, церебраль-ный инсульт в России составляет 21,4% в структуре общей смертности, при этом 31% пациентов, пере-несших инсульт, нуждаются в постоянном уходе, 20% не могут ходить и только 8% возвращаются к прежней деятельности [1].Согласно рекомендациям ВОЗ [2], выделяют три уровня последствий заболевания. Первый уро-вень -неврологические повреждения, к ним отно-сят: двигательные, чувствительные, тонусные, пси-хологические расстройства, которые выявляются в клинической картине заболевания. Второй уровень -нарушения функции, к которым могут привести неврологические повреждения, например наруше-ния ходьбы, самообслуживания. Третий уровень -ограничения, он включает нарушения бытовой и со-циальной активности, возникающие в резул ьтате неврологических повреждений и нарушений функ-ций.Таким образом, последствия инсульта прояв-ляются на клиническом, функциональном и соци-альном уровнях. После перенесенного инсульта лишь в 10-15% случаев происходит восстановле-ние на всех трех перечисленных уровнях. В этой связи актуальной является задача совершенствова-ния методов восстановительного лечения инсуль-
Medical rehabilitation is now a priority of the Russian Healthcare [Skvortsova V.I., 2012]. Rehabilitation centers are usually located in big cities and are not available for most patients. Therefore, one of the modern trends in the development of rehabilitation is a distantly controlled rehabilitation. We have developed a program of distant rehabilitation in Russia, based on our own achievements and experience of foreign colleagues. The article provides an overview of methods according to world literature studies. The survey shows that the problem of distant rehabilitation is relevant in our time, and requires additional clinical research and technological development.
The report is devoted to modern methods of neurorehabilitation, which are actively being introduced into the clinical practice of rehabilitation treatment centers. The technologies used at all stages of rehabilitation are described, starting from the intensive care unit, ending with remote methods used after the patient is discharged from the hospital. We consider robotic technologies, mechanotherapy with biofeedback, non-invasive stimulation techniques, virtual reality technology. Data on the effectiveness of rehabilitation treatment procedures from the perspective of evidence-based medicine are presented.
The problem of providing a continuous staged rehabilitation treatment of patients with severe associated injuries musculoskeletal system is an urgent and important task. This article describes two clinical cases of successful comprehensive medical rehabilitation of disabled persons with severe combined trauma and multiple injuries skeleton in need of long-term continuous rehabilitation program which was successfully launched at the stage of hospital care and continued remotely, through on - line technologies in a familiar patient home medium. As a result of rehabilitation treatment was observed: increased mobility of patients and level of independence in daily life, increased range of motion in the affected joints, increase muscle strength of the affected limbs, improving psycho - emotional status of patients resocialization and adaptation to the familiar home environment.
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