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During the years of widespread use of radiotherapy in cancer patients, the incidence of local radiation damage to soft tissues (of varying severity) reached 30–40% or more. The experience of the radiation injury treatment department in the 70s and 80s indicates that every 2–3 beds were occupied by patients with this pathology. With the development of radiology, the introduction of new sources and techniques, the frequency of formation of such changes in the zone of irradiation fields has significantly decreased and currently stands at about 2%. The purpose of the proposed study is to demonstrate the possibilities of skin plastic surgery in this contingent of people who, as a rule, do not receive qualified care for a long time. As part of the work carried out, the time elapsed from the moment of formation of pathological changes to hospitalization in the department, on average, was 3–5 years, and was filled with ineffective conservative measures. Over the past 4 years, 60 reconstructive plastic surgeries have been performed in the radiation injury treatment department using musculoskeletal (21), skin fascial (21), skin (10) flaps, as well as plasty with local tissues (8). In the early postoperative period, the most common complication was marginal necrosis of the flap (13) which in 11 patients caused repeated operations in the form of secondary sutures or, in the case when it was not possible to perform this, plastic surgery of the defect with insular skin flaps was applied to the granulating wound. Subsequently, complete healing of the postoperative wound was noted in such patients. Thus, the proposed options for the reconstruction of radiation ulcers that developed after combined and radiation treatment of malignant neoplasms are highly effective methods that can get rid of disfiguring defects, improve the quality of life and restore social activity in almost 100% of patients.

Introduction. The development of a comfortable living environment for persons with disabilities is one of the most important tasks in the modern world. To a large extent, its implementation depends on housing conditions of wheelchair users, as well as principles of their settlement in multi-apartment residential buildings in cities. Physical barriers in the architectural environment are the most pressing problem hindering rehabilitation and socialization of disabled persons. Uncomfortable housing conditions can hinder therapeutic and preventive care aimed at health improvement, and physical barriers in housing and yard spaces can hamper the socialization of disabled residents. The problem is more relevant than ever, because due to the ongoing Special Military Operation, the number of physically challenged persons is growing fast. With this in mind, it is important to continue adapting residential buildings for limited mobility population groups and creating a more comfortable environment for all urban residents.Materials and methods. The article analyzes (1) the way wheelchair users take up residence in large-scale development areas in the post-war Krasnodar, (2) the settlement of wheelchair users in urban districts, (3) the residence of wheelchair users in buildings with a different number of storeys. Contradictions are identified between current urban development conditions and surrounding architecture, on the one hand, and the needs of limited mobility residents, including their socialization, on the other hand. Criteria for selecting design solutions are developed; recommendations are provided for the reconstruction of existing residential buildings, equipping and modernizing the urban environment, raising awareness of problems to be tackled by disabled persons.Results. A list of steps is proposed to solve problems of housing conditions and principles of resettlement of disabled persons. In particular, factors impeding the treatment, preventive care and socialization of wheelchair users are considered, and their elimination plan is proposed. The article provides a theoretical justification for techniques and principles of architectural design of buildings, taking into account the accessibility of standard residential buildings to limited mobility persons.Conclusions. The article describes methods and techniques for solving several most important problems of wheelchair users in Krasnodar, in particular, their accessible living environment. The appropriateness of the settlement of disabled persons in the existing urban development and reconstruction of this architectural environment were analyzed; methods for designing buildings that meet the housing requirements of limited mobility persons were presented. Also, a social approach to developing a comfortable living environment for such members of society was formulated and analyzed to ensure their integration into the life of society, equal access to infrastructure, work and education.

The increase in the share of the retirement age population in Russian demographic structure aggravates the issues of ensuring a decent standard and quality of life for such citizens. Aspects of not only material support come to the fore (although this is not at a very high level relative to international standards), but also aspects of providing quality medical service, solicitude, assistance and, if necessary, long‐term care. Aim. To assess the impact of the development of a long‐term care system on the socio‐economic status of people of retirement age. Methods. Comparative analysis, statistical data analysis, content analysis, generalization and synthesis of data. Results. The proportion of people of retirement age is increasing, and their financial condition is worsening. To maintain a decent standard of living after reaching retirement age, many pensioners must continue working. At the same time, as people age, age‐associated diseases develop, the consequences of which are the need to provide such citizens with additional assistance, solicitude and even long‐term care. These services are provided to citizens within the framework of the current health care system and through social protection authorities, however, statistical data indicate a very low level of coverage of pensioners with such services and a high demand for them. The main burden of care falls on able‐bodied relatives and friends, which affects their employment. The implementation of a pilot project in certain regions of the country to introduce a long‐term care system has yielded positive results in the form of improvement in the physical and psycho‐emotional state of both recipients of such services and their relatives providing care. Thus, a conclusion was made about the importance of developing a long‐term care system as a permanent part of the social security of older citizens to improve the quality and standard of living, not only for them, but also for their families.

of early stages of deforming osteoarthritis of the knee joint. There is a need to explore the effectiveness and mechanisms of modern methods of electrical therapy and their impact on the quality of life due to close cause-and-effect relationship between the pain, inflammatory and destructive components of osteoarthritis (OA) as one of the most common conditions. The objective was to evaluate the effect of interstitial electrical stimulation (IES) as a monotherapy in the course of conservative treatment of early stages of gonarthrosis based on clinical and biochemical findings. Materials and methods Radiographic findings, skin electrometry (objective parameters of pain intensity), limb weight-bearing capacity, biochemical parameters of connective tissue matrix degradation in blood serum and 24-hour urine samples, and treatment satisfaction were explored in 43 patients. Patients who received a course of IES were assigned to the treatment group (n = 22) and patients who received standard treatment without IES constituted the control group (n = 21). Results Electrometric analysis showed a higher effectiveness of pain relief in the treatment group compared to the controls with asymmetry coefficient measuring 3.2 ± 0.31 versus 1.9 ± 0.4 at p > 0.05. The weight‑bearing scored 3.59 ± 0.34 versus 3.26 ± 0.2 at p > 0.05. The treatment group showed shorter treatment length with 13.21 ± 1.2 days versus 18.3 ± 1.2 days in the control group at p > 0.05 and a higher degree of satisfaction with outcomes scored 96.2 ± 2.59 in the treatment group versus 86.2 ± 3.17 in the control group. A statistically significant difference (p > 0.05) was established in the levels of free and total hydroxyproline characterizing the different intensity of collagen breakdown in the groups at the end of treatment. Discussion The IES used as an analgesic and anti-inflammatory therapy was shown to be highly effective with changes in the hydroxyproline level in the media suggesting a chondroprotective effect. The analysis and comparison of objective parameters demonstrated high effectiveness of IES in the treatment of early stages of gonarthrosis in middle-aged and elderly adults. Conclusion The IES used for treatment of early stages of gonarthrosis helps pain reducing the intensity of collagen destruction and improving weight-bearing.

As of the beginning of 2023, there are more than 660 million convalescents of a new coronavirus infection in the world, however, even despite successful treatment of the acute period of the disease, such patients have a high risk of developing long-term complications in the post-COVID period, primarily cardiovascular events. One factor that seriously increases the risk of these complications is the state of lowgrade systemic inflammation (LGSI). LGSI is not a clinical diagnosis, it is characterized by a level of C-reactive protein in peripheral blood in the range of 3–10 mg/l and is most often detected during routine examination of patients, who in most cases have no clinical symptoms. In this regard, the condition of LGSI most often remains unnoticed and unreasonably ignored, despite quite extensive literature data on the effect of LGSI on the pathogenesis of many cardiovascular diseases. The development of drug therapy for LGSI is complicated by the multifactorial etiology of this condition. The causes of LGSI can be both genetic factors, which are practically impossible to correct, and conditions that are amenable to drug and non-drug treatment, such as, for example, increased intestinal permeability to pro-inflammatory agents, including lipopolysaccharide of gram-negative flora, the presence of a chronic untreated infection site and endocrine pathology (obesity and type 2 diabetes). This review presents the main information to date on the state of LGSI in patients who had a new coronavirus infection, including the results of our own observations of patients who have undergone a course of rehabilitation measures, as well as the most significant, in our opinion, factors predisposing to the development of LGSI in such patients.

The purpose of this study was to objectively assess the effectiveness of rehabilitation using balneotherapy with velvet antler products. Materials and methods. Doppler assessment of coronary artery blood flow was performed. As a reference vessel, we chose the anterior descending artery, which is the largest branch of the left coronary artery and has its own numerous branches providing blood supply to the main part of the functionally active left ventricle myocardium. We studied the following groups of patients, whose rehabilitation included balneotherapy with velvet antler products: 1) 48 subjects with stage 2 arterial hypertension and 2) 49 subjects with coronary artery disease after balloon angioplasty and coronary artery stenting. In addition to balneotherapy, group 1 received standard hypotensive therapy with angiotensin-converting-enzyme inhibitors, beta blockers and thiazide diuretics, while group 2 was given indirect anticoagulants, beta blockers and new generation statins. Before and upon completing the treatment course, each patient’s peak blood flow velocity was measured, as well as blood flow integral in the proximal segment of the anterior descending artery. Results. After the balneotherapy course, most patients in both groups showed quiet and increased activation of high reactivity level. According to our observations, patients tolerated the treatment well. Initially, peak blood flow velocity and blood flow integral were recorded within the range of 28–45 cm/s (mean: 36.9 ± 4.4 cm/s) and 9–14 cm (mean: 11.00 ± 1.25 cm), respectively, without between-group differences. After the multimodality treatment that included balneotherapy with velvet antler products, these parameters were recorded within the range of 39–52 cm/s (mean: 45.7 ± 3.5 cm/s) and 11–16 cm (mean: 14.0 ± 1.3 cm), respectively, with no between-group differences either. The increase in peak blood flow velocity was statistically significant (p ˂ 0.001). Thus, balneotherapy using innovative velvet antler products combined with medication treatment and physical therapy, presumably, contributed to improving coronary blood circulation in patients with stable ischemic heart disease and arterial hypertension.

Introduction. Approximately 80% of people experience back pain throughout their lives. A common problem of patients with low back pain is a significant limitation of mobility. Rehabilitation programs are usually recommended. Programs should include exercises that build flexibility, endurance, and strength. Kinesiotherapy is complemented by physiotherapy procedures, which are mainly aimed at analgesic and relaxing effects. The aim of the study was to compare the effect of two rehabilitation programs that differ in the type of kinesiotherapy on the mobility of the lumbar spine and the level of pain intensity in people with L5-S1 segment discopathy. Materials and methods. The study involved 30 patients undergoing 14 days of rehabilitation treatment. The criterion for dividing the subjects into groups was the method of kinesitherapy. The first group (Gr1) consisted of 15 patients who did gymnastics in the pool twice a day, and the second group (Gr2) consisted of 15 patients who attended therapeutic gymnastics classes in the gym twice a day. The exercises were aimed at improving the range of motion of the spine, strength and endurance of postural muscles. A visual analog scale was used to assess the intensity of pain. The distance between standard anthropometric points in the resting position and in the extreme position of movement was measured to assess the range of spinal movements. Results. After rehabilitation, the amplitude of movements of the lumbar spine increased in most patients. In Gr1, an increase in the range of forward spinal flexion by 9.2 cm (p = 0.001), rotation to the right by 0.63 cm (p = 0.03), and to the left by 1.33 cm (p = 0.007) was detected. In Gr2, the range of forward flexion increased by 12.6 cm (p = 0.005), left rotation by 0.94 cm (p = 0.035), and right flexion by 1.41 cm (p = 0.002). In the case of other movements, no statistically significant changes were found. In Gr1, the average pain intensity according to the VAS was 4.9 ± 2.3 points before the start of the physiotherapy program and 3.6 ± 1.7 points after its completion (p = 0.04). In Gr2, the VAS values were 5.1 ± 2.5 points and 3.9 ± 1.8 points, respectively (p = 0.03). The magnitude of changes in pain intensity was similar (-1.3 points and -1.2 points) for both programs. Conclusions. 1. The applied rehabilitation programs increased the mobility of the lumbar spine and reduced pain in patients with L5-S1 segment discopathy. 2. Both the hydrokinesitherapy program and the gym program were equally effective in increasing the range of motion of the spine and reducing the intensity of pain.

The aim: is to compare short-term results of home-based and outpatient programs of physical therapy among patients with frozen shoulder and concomitant thoracic myofascial pain syndrome. Materials and methods. The study involved 80 patients. The range of motion in the shoulder joint affected by capsulitis was assessed. A numerical pain scale was used to assess pain sensations when pressing on trigger points. Functional limitations in the shoulder were measured by means of the Oxford Shoulder Score (before and 1.5 months after the end of the physical therapy). Participants were divided into two groups: home-based group (HG) and outpatient group (ОG). All the patients were consulted by a physical therapist. ОG patients received end-range mobilization with the assistance of a physical therapist 5 times a week to improve shoulder joint mobility. Most of ОG participants received 15 procedures (3 weeks). Patients HG performed therapeutic exercises without any assistance at home. (twice a day, 3 weeks). In terms of trigger points therapy, the patients performed ischemic compression without any assistance. Results. Patients of both groups demonstrated positive dynamics of the studied indicators. Comparison of the short-term results of the therapy according to range of motion and pain showed better indicators in the ОG. Comparison of the initial results of the groups in Oxford Shoulder Score items did not reveal any significant differences. Total score was 18.2±6.5 points in ОG and 17.6±7.5 points in HG (p=0.715). Me (25%; 75%) values were 17.5 (12.5; 23.8) and 18 (13; 23.5) points, respectively. Comparison of the final results of the groups in Oxford Shoulder Score items revealed significant differences. Total score was 47 (47; 48) points in ОG and 33 (31; 35.75) points in HG (p

Рost-COVID-19 syndrome (PS) is one of the medical and social problem. According to WHO, 10–20% of COVID-19 patients suffer from PS. The use of medical gases – inhaled nitric oxide (iNO) and molecular hydrogen (iH2) – may influence on the mechanisms of development PC. Aim. To evaluate the safety and efficacy of the combined inhalation of NO and H2 (iNO/iH2) in patients with respiratory manifestations of PS. Materials and methods. 34 patients with PS (11 men/23 women, 60.0±11.7 years) were included in the prospective open-label controlled study in parallel groups: the main group (n=17) received iNO/iH2 for 90 minutes once a day for 10 days (concentration of NO 60 ppm, H24% in the gas mixture), the control group (n=17) didn’t receive inhalations. The period from the confirmation of COVID-19 to the start of the study was 641.8±230.5 days. The groups did not differ in the baseline parameters. The clinical symptoms (from the self-observation diary and mMRC questionnaires, "dyspnea language"), FAS, HADS, SF-36 scores, 6-minute walk test, the blood serum parameters of oxidative stress, the dynamics of the microcirculation in the eye bulbar conjunctiva were evaluated. The individual dose of iNO has chosen during a 15-minute test (the positive dynamics of the microcirculation have indicated that the dose was selected correctly). Results. The decrease the symptoms severity, such as dyspnea, cough, fatigue and palpitations (p0.005), the increase in SF-36 questionnaire scores (p=0.006) and a reducing of FAS score (p=0.001), as well as the anxiety component of HADS (p=0.02) were revealed at the end of treatment in the main group compared to the control group. We observed an improvement in distance walked (p=0.01) and the values SpO2 (p=0.04) in 6-minute walk test, the increase in the volumetric blood flow velocity in venules (p0.001), and the date in oxidative damage (p0.001) and antioxidant activity (p=0.03) parameters in the blood serum. Conclusion. The results of the study demonstrate clinical efficacy iNO/iH2 on clinical indicators, parameters of oxidative stress and microcirculation in patients with PS.

The degree of damage to spine is now a threat to health and optimal functioning of the human body in the post-traumatic period. Taking into account the peculiarities of the mechanism of psychogenic disorders in the conditions of the full-scale Russian invasion contributes to the specialist’s readiness for stress and conflict situations during the rehabilitation period of work with the victims. The purpose of the article is to substantiate the dynamics of the effectiveness of providing multidisciplinary rehabilitation care to victims with spinal cord injuries. Psychocorrection should contain a list of training exercises aimed at the development of self-awareness, improvement of psychological culture, improvement of reflective personality characteristics, self-actualization and will involve mastering the skills of voluntary psychophysical self-regulation of the state. Research methods. Among psychodiagnostic methods, the following were used: the questionnaire «Change in the quality of life due to the disease», the method of determining the intensity of the pain syndrome according to the visual analog pain scale (VAS) and the Minnesota Multi-Profile Personality Questionnaire (MMRI-2) to assess the psychological status of the individual. The characteristics of motor activity were determined according to the dynamics of Hauser’s gait index, which determines the mobility of the victim and his ability to move freely and the need for auxiliary means of support. Research results. In subjects with spinal cord injury during hospitalization and psychocorrection changes in the gait state according to the Hauser index (muscle strength) were improved from 3.18±0.13 points on average for the group to 4.9±0.63 after the injury. This indicates that after 10-12 months’ treatment all subjects moved without the help of other attendants, some of whom were completely independent, within and outside the home to overcome thresholds and low curbs. Motor activity and gait were improved; there was a noticeable decrease in the intensity of pain, anxiety and depression.

Background. Postcovid syndrome or Long COVID is a new term introduced into medical practice by WHO after the COVID -19 pandemic. Long COVID affects patients who have recovered from COVID -19. Objectives. The purpose of this work is to understand cognitive deficits caused by COVID-19 from the point of view of neuropsychology and pathophysiology. Data Sources. Literature search was conducted in the following electronic databases: Pubmed, Google.scholar and Scopus databases. 63 articles were selected. Keywords for the literature review included “neuropsychiatry/neuropsychology”, “pathophysiology”, “COVID-19”, “SARS-CoV-2”. Methods. Review and analysis of COVID-19 studies in terms of its relation to the appearance of cognitive deficits in patients. Results. The SARS-CoV-2 virus enters the human body and affects the structures of the brain. Some of the symptoms such as fatigue, shortness of breath, problems with concentration and memory, loss or change of taste and smell, pain in muscles and joints as well as sleep disorders are preserved in post-COVID period and may be explained by the peculiarity of the virus interaction with central nervous system. Neuropsychological analysis of observed disorders based on the theory of three functional blocks of the brain by A. R. Luria helps to identify the affected zones of the functional systems of higher mental functions (HMF). Neuropsychological assessment makes it possible to plan rehabilitation programme or cognitive training, and help doctor in choosing an adequate drug therapy to compensate for cognitive impairment. Conclusions. SARS-CoV-2 causes damage to brain structures such as the brainstem, limbic system, prefrontal cortex and olfactory tract, which explains the observed symptoms. Neuropsychological diagnostics makes it possible to identify the impaired component of the HMF in patients with post-COVID syndrome, to plan an adequate rehabilitation programme, as well as to choose drug therapy.

The literature review evaluates the rehabilitation measures in the country's oncological institutions, assesses regulations in other countries, and scientific publications related to the rehabilitation of cancer patients. Studies were analysed using electronic databases PubMed, Medline, Science Direct, Scopus, Web of Science, e-Library, RSL. Over 47,900 sources were found, of which 50 papers over the past ten years were selected and included in the article. The criteria for inclusion were the rehabilitation of cancer patients, stages of rehabilitation, pre-rehabilitation, nutritional support, psychological assistance, and quality of patients’ life. Considering the urgency of the problem, WHO 2017 took the initiative and adopted the Rehabilitation 2030 program, which provides expanding global access to high-quality rehabilitation as an essential health service for people with non-communicable diseases. According to summarized data, rehabilitation is based on the following principles: stage-by-stage process, consistency, complexity, and individual approach. The stages of medical rehabilitation of cancer patients include pre-rehabilitation; stage I – a period of specialized treatment; stage II – rehabilitation in a hospital setting after discharge; and stage III – early and late rehabilitation periods. An analysis of the situation in Tajikistan showed that in oncology-related institutions, rehabilitation of cancer patients is carried out within the framework of existing protocols for individual nosology, where a set of measures for the stages of rehabilitation is not sufficiently developed. A practical assessment of the effectiveness of rehabilitation is not set up. The stereotype about limiting the use of physiotherapy and sanatorium-resort treatment for cancer patients persists. There are no regulations for comprehensive rehabilitation of cancer patients. The need to optimize treatment results, prolong the survival of patients with various functional disorders, and improve the quality of life dictates the necessity for the development and systematic implementation of comprehensive rehabilitation of cancer patients.

Background. Despite the visible successes of domestic phthisiology at the present time, the problem of medical rehabilitation of patients with tuberculosis remains relevant. In recent years, approaches to medical rehabilitation of patients with various diseases have changed significantly, which entail the need to consider a complex of rehabilitation measures for patients with tuberculosis from the perspective of the Procedures for organizing medical rehabilitation in adults and children and their integration into phthisiatric practice.The aim. To study the organizational aspects of medical rehabilitation of patients with respiratory tuberculosis in the world and the Russian Federation.Methods. We carried out an analysis of domestic and foreign literature, regulatory documents on the organization of rehabilitation for tuberculosis patients for 2018–2023 in electronic databases PubMed/Medline, Google Scholar using terms “tuberculosis, pulmonary/rehabilitation” in English and Russian languages.The results show a growing amount of factual information demonstrating the positive effect of pulmonary rehabilitation in patients with respiratory diseases, including tuberculosis. The analysis revealed defects in the organization of the medical rehabilitation system in the structure of medical care for tuberculosis patients in the Russian Federation. This concerns problems of routing, phasing, organizational models, human and material resources, standardization of the main components of the rehabilitation process, the significance and effectiveness of certain rehabilitation measures, which leads to low availability of rehabilitation care for tuberculosis patients. Deficiencies in the regulatory framework prevent the integration of medical rehabilitation into the practice of TB services.Conclusion. Modern issues of organizing rehabilitation care for patients with tuberculosis require further study and improvement. The development of a system of medical rehabilitation of patients with tuberculosis helps to increase the effectiveness of treatment, to reduce the number of complications, disability, mortality due to tuberculosis, and to increase the duration and quality of life of patients.

Relevance. The hand grip strength measurement together with neuromuscular block monitoring played an important role during surgery. They both helped in losing less time during surgery and also facilitate the task of the surgeon. The aim of this study was to reduce time on intubation, facilitate the task of the surgeon and to limit post-surgical pain. In rehabilitation, hand grip strength helps in determining further recuperation measures after asurgery. There are three fundamental principles for an anesthesiologist to ensure that the patient after combined endotracheal anesthesia can be extubated, the first one is to ask the patient to move his head forward, the second one is to ask the patient whether the intubation tube is disturbing him in his mouth and the third most important one is to make the patient hold his wrist very firmly. Materials and Methods. Monitoring of muscle relaxant on induction, intra and post-surgery is carried out using aTOF Watch SX in coordination with handgrip strength measurement on 46 patients aged from 18 to 60 years of BMI of 18-30 kg/m² 15min before endotracheal intubation and 15min, 45min and 210min post extubation by using adynamometer “MEGEON 34090” to help us understand whether after extubation muscle strength changes and to what extent. Also, pre-anesthesiology protocol, combined endotracheal protocol, Microsoft excel advanced, monitoring of hemodynamics, ECG, PEEP, PCO2, PO2, respiratory volume using Drager Fabius. Results and Discussion. The results showed that to reach deep muscle relaxation both atracurium benzilate (FKP Kursk Biofabric company, Kursk, Russia) at TOF 0 took 258.5± 83.5 secs and Cisatracurium benzilate (ZAO Obninsk Chemical pharmaceutical company, Obninsk, Russia) at TOF0-252.4±100.1 secs in emergency patients and basically hand grip strength also was lesser as compared to planned cholecystectomy patients. Conclusion. Rehabilitation was necessary for patients undergoing massive abdominal emergency surgeries underlying the fact that on apain scale 10/10 post surgery, further treatments should be implemented to reduce pain, reduce residual neuromuscular block and muscle weakness after extubation at TOF 90-95%.

The aim of the study is to conduct a comparative analysis of the effectiveness of the methods of unilateral biportal endoscopic discectomy and interlaminar microdiscectomy among patients operated on for herniated intervertebral discs of the lumbar spine. Materials and methods. The study was conducted at the Department of spine and spinal cord neurosurgery of the Regional Clinical Hospital of the Ivano-Frankivsk from May 2021 to August 2022. The sample consisted of 99 patients with intervertebral disc herniation (at the level of L2-L3, L3-L4, L4-L5, L5-S1), including 44 men and 57 women. Criteria for intergroup distribution: group 1 (n = 43) – removal of the intervertebral disc herniation was performed by the method of unilateral biportal endoscopic discectomy; group 2 (n = 56) – interlaminar microdiscectomy was performed. Examination methods - VAS (cm), Oswestry questionnaire after 1 month, 6 and 12 months, respectively. Statistical processing of the results was carried out using Microsoft Excel and Statistica 8.0 (StatSoft Inc.). Results. In the preoperative period, the back pain index was 6,9±1,1 and 6,7±1,4 in groups 1 and 2, respectively. In the postoperative period in group 1, the back pain index according to VAS decreased from 6,9±1,1 cm to 1,9±0,5 cm the next day, with positive dynamics remaining during the year of observation of 0,2±0,2 cm, respectively. In group 2, at the time of discharge, the pain index was noted at the level of 3,5 ± 0,9 cm with a gradual improvement to 0,7 ± 0,5 cm. Assessment of the severity of radicular pain in the leg in the postoperative period after 1 month showed a significant improvement in both groups: in group 1 from 7,2±0,6 cm to 0,5±0,5 and in group 2 from 7,8±0,5 cm to 0,5±0,3 cm. Significant differences between observation groups during the last survey was not detected. The duration of the operation when using endoscopic access was lower than during microdiscectomy (35,7±15,2 min (M±SD)) and (45,8±13,7 min (M±SD)), respectively (р≤0, 05). The amount of blood loss was 3,8 times less determined during endoscopic access ((35,4±18,9 ml (M±SD)) and (122,2±90,9 ml (M±SD)), respectively (р≤0,05). The length of stay in the hospital was shorter in the endoscopic discectomy group. Conclusions. The method of unilateral biportal endoscopic microdiscectomy, due to its low trauma, allows the patient to return to an active lifestyle more quickly compared to open microdiscectomy. No significant differences were found according to VAS and Oswestry indicators at the remote stage of observation.

Introduction. The recurrence of pulmonary tuberculosis remains a significant public health problem in many countries of the world, despite the remarkable progress in the treatment and rehabilitation of patients with new cases of tuberculosis. It is demonstrated that the high incidence of recurrence of pulmonary tuberculosis is conditioned by the influence of some factors combination. Currently, the comorbidities, which impose the risk of disease recurrence directly or indirectly, are of a major importance. Thus, it is important to study the clinical and epidemiological characteristics of pulmonary tuberculosis recurrence associated with the comorbidities. Materials and methods. There were studied 715 patients with pulmonary tuberculosis recurrence, including 503 patients with comorbidities, as well as statistical reporting data for the Right Bank region of the Dniester River and ATU (Autonomous Territorial Unit) of Gagauzia, Republic of Moldova during 2019-2021. Results. The obtained results demonstrate that in phthisiopulmonology the presence of comorbidities constitutes a significant and important medico-social problem. In the structure of relapses associated with comorbidities, it was noted the predominance of extensive infiltrative processes, high frequency of cases with destruction in the lung tissue and bacillary cases. The need to review and improve the general antituberculosis measures accepted both in the work of phthisiopneumologists and primary care specialists is argued in order to improve the prognosis of TB treatment associated with comorbidities. Conclusion. The recurrence of pulmonary tuberculosis associated with comorbidities requires an integrated multidisciplinary approach.

Aim of the study was to evaluate the effectiveness of early rehabilitation methods for medical workers with severe or moderate lung damage caused by a new coronavirus infection, who are in intensive care units, to improve lung ventilation, gas exchange and bronchial clearance, correct muscle weakness, increase overall physical endurance, mobility, psycho-emotional stability.Material and methods. We examined 53 COVID-19 women with moderate lung injury at stage I of rehabilitation, divided into two groups: main (n = 31, medical personnel) and control (n = 22, working outside of contact with pulmotropic risk factors, including no risk of SARS-CoV-2 infection). Early rehabilitation was carried out in the intensive care unit and in the infectious diseases hospital of City Clinical Hospital No. 2, for patients with COVID-19 rehabilitation plan was drawn up in accordance with temporary guidelines for the medical rehabilitation of a new coronavirus infection.Results and discussion. It was established, that rehabilitation in the conditions of the intensive care unit and the specialized department can significantly reduce the severity of dyspnea, anxiety and depression, positively affects the increase in exercise tolerance, and helps to reduce the activity of systemic inflammation. In patients who have industrial contact with patients with COVID-19, the effectiveness of rehabilitation measures is lower than in the comparison group.Conclusions. To increase the effectiveness of stage I of the rehabilitation of medical workers with COVID-19 and lung damage, it is necessary to conduct more intensive and longer rehabilitation than indicated in the current guidelines.

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Breast cancer ranks first in the structure of cancer incidence. Considering fatality reduction within a year since the moment of the diagnosis verification, it can be assumed that the screening programs and complex treatment are effective. However, after treatment patients face a number of challenges reducing their quality of life, which can be overcome by conducting high-quality medical rehabilitation in a timely manner. Based on the key features, this medical process requires a complex approach and accessibility for all regions of our country within the state budget.

Diseases of the nervous system, accompanied by impaired locomotor reactions, occupy a leading place among the causes of disability. In this regard, the review carried out an analysis of national and foreign scientific data devoted to current views about the neurophysiological mechanisms of plasticity and their leading role in ensuring the recovery of movements in neuromotor disorders. Special attention is given both to the organization of the spinal locomotor center as a common final path in the implementation of motor rehabilitation, and to the management of the locomotor center, taking into account modern ideas about the structure of the locomotor body system. Based on the results of systematic literature data, the authors concluded that neuroplasticity of the spinal locomotor center and supraspinal centers of movement regulation is proven, and indicate the expediency of searching for methods which activating the plasticity of the central nervous system.

The article is devoted to the analysis of the German and Romanian captivity of the cadets of the Yaroslavl Military Aviation School of Fast Bombardiers. There is no special research devoted to this group of prisoners of war in Russian and foreign historiography. The author has determined the time, place, and circumstances of taking the cadets captive; counted their number; found out the location of the camps where they were held. Based on sources of personal origin, the author has established survival strategies in difficult conditions of captivity, forms of resistance, the fate of cadets after their release as well as the names and dates of death of some cadets who died in captivity. The author concludes that Yaroslavl cadets differed from the vast majority of Soviet prisoners of war in their level of education and intelligence, unconditional adherence to communist ideology, good physical fitness, and a sense of camaraderie. They were captured as a result of the defeats of the Red Army in the battles of May–July 1942 at the Crimean and Southern fronts. Like other Soviet prisoners of war, Yaroslavl cadets became victims of the Nazi genocide. Some of them died during the first months in captivity of starvation and diseases caused by it, targeted executions, and suicides. Some improvements in nutrition and accommodation of Soviet prisoners of war, made by the Nazis in order to maximize the use of their labor, increased the cadets’ chances for survival. They spent more than two years in Romanian captivity, and almost three years in German captivity. Maintaining friendly relations with former co-servicemen and other prisoners of war turned out to be a successful survival strategy for the captured Yaroslavl cadets. Along with this, they resorted to concealing their military rank and the presence of a special military education from the enemy. The main forms of anti-fascist resistance of cadets were sabotage at workplaces, escapes, and the continuation of armed struggle with the enemy in Soviet and foreign partisan detachments. Like other Soviet prisoners of war, they were subjected to checks by Soviet security agencies after their release and then tried to prove their loyalty to the Motherland on the war fronts. Nevertheless, for decades, the fact of having been held captive created obstacles to continuing education, career growth, and normal life.

Lymphedema is the tissue fluid accumulation that arises as a consequence of impaired lymphatic drainage. Secondary lower limb lymphedema after surgery in cervical cancer is a result of combined antitumor treatment and significantly reduces the quality of life. The management of lymphedema by physical therapists usually includes a combination of skin care, physiotherapy, external pressure, exercise, and massage. This case report describes the course of treatment for a 53-year-old female with stages IIIB secondary lymphedema. The goal of physical therapy intervention was as restoration of the functionality of the affected lower limb. The rehabilitation tasks were as to reduce total limb volume, return of the stereotype of gait, decrease in the level of anxiety. Decongestive lymphedema therapy was effective in treating this patient with secondary lymphedema of the lower extremities. Although the goal of rehabilitation was partially achieved, the patient was discharged from the hospital in a good mood, her anxiety level decreased, her gait stereotype improved, and her endurance increased. Improving the functionality of the limb, improving its appearance had a positive impact on the quality of life and allowed her to return to work. This case report testifies to the effectiveness of complete decongestive therapy even in the case of severe lymphedema. The clinical result of such rehabilitation programs makes it possible to increase the adaptive potential and social independence of cancer patients.

Background. The perception of time perspective in substance-dependent individuals is considered as a dynamic characteristic of the personality, which can be both a predictor of the effectiveness of self-determination in life and a risk factor for further abuse of alcohol and drugs. Assisted forming of a balanced time perspective and a positive attitude toward all time dimensions has the potential to improve rehabilitation programs and the effectiveness of psychological interventions for substance-dependent individuals. Objective. The article aims to summarize the most significant published current national and international research on the topic of time perspective perception in substance-dependent individuals. An analysis of current directions and prospects for further study of the problem are suggested. Methods. The selection and analysis of studies of the last 10 years on the topic of time perspective in substance-dependent individuals were carried out. Results. A scientific review of studies was carried out in the following areas: 1) time perspective in substance-dependent individuals; 2) possibilities of psychological intervention for time perspective modification. Conclusion. The analysis of scientific publications has shown that a time perspective in substance dependence is a relevant area of international research. Based on the findings, methods and approaches of psychotherapeutic assistance to substance users in the process of their rehabilitation are being developed and improved. Russian research on the time perspective of substance users is represented by a small number of studies, which mainly consider imbalanced temporal orientations as a risk factor for relapse into addictive behaviour. A multi-faceted study of temporal perspective and its balance at different stages of rehabilitation has the potential to improve the effectiveness of psychotherapeutic work.

Introduction. Non-invasive brain–computer interfaces (BCIs) enable feedback motor imagery [MI] training in neurological patients to support their motor rehabilitation. Nowadays, the use of BCIs based on functional near-infrared spectroscopy (fNIRS) for motor rehabilitation is yet to be investigated. Objective: To evaluate the potential fNIRS BCI use in hand MI training for comprehensive post-stroke rehabilitation. Materials and methods. This pilot study included clinically stable patients with mild-to-moderate post-stroke hand paresis. In addition to the standard rehabilitation, the patients underwent 10 nine-minute MI fNIRS BCI training sessions. To evaluate the quality of fNIRS BCI control, we assessed the percentage of time during which the classifier accurately detected patient's mental state. We scored the hand function using the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA). Results. The study included 5 patients at 1 day to 12 months of stroke. All the participants completed the study. All study participants achieved BCI control rates higher than random (41–68%). While three patients demonstrated the clinically significant improvements in their ARAT scores, one of them also showed an improvement in the FMA score. All the participants reported experiencing drowsiness during training. Conclusions. Post-stroke patients can operate the fNIRS BCI system under investigation. We suggest adjusting the feedback system, extending the duration of training, and incorporating functional electromyostimulation to enhance training effectiveness.

Literature data and own experience of nutritional support in oncology has been analyzed. Nutritional support is an integral part of the management of cancer patients. Diagnosis of nutritional deficiencies is important, with an accent on early detection of muscle loss and severely malnourished patients. The main methods of nutritional support are oral nutritional supplements, enteral and parenteral nutrition, as well as dietary advice and maintenance of physical activity. Oral nutrition should always be used in the absence of absolute contraindications. The effectiveness and indications of prehabilitation measures require further study, but now it is possible to single out a category of patients in whom they can be fully implemented. It can be cases requiring neoadjuvant chemotherapy.

The article analyzes the place and role of two novels, The Lady of the Camellias by Alexandre Dumas fils (1848) and Madame Bovary by Gustave Flaubert (1856), in Dostoevsky’s novel The Idiot (1868). It demonstrates how Dostoevsky introduces Dumas’ text in order to reflect on the falseness and destructiveness for the spirit of man of its key idea, which is the parallel between the compassion for fallen women that Dumas seeks to call for through the novel and the salvation of sinners by Jesus Christ. Besides, the article pays attention to the fact that Dumas considers the rehabilitation of such women, meaning the restoration of their social rights through marriage, the highest expression of humanity. It is shown that Dostoevsky, in his novel, reveals on a symbolic level that marriage in its earthly secularized form does not lead to spiritual restoration, as Dumas suggested, nor does it give real happiness. The article also analyzes the main ideas of Flaubert’s novel. It is argued that Dostoevsky specifically introduces Madame Bovary into his novel because it reveals the catastrophic situation of a corrupt world that has lost touch with God precisely through the image of marriage as a trap into which people fall because of deception. They seek in it a higher relationship; however, not obtaining it, they are devoured by their own lust and passions, which take hold in the absence of a connection with another level of being.

Hysterical neurosis affects social perception and, thus, the quality of life. This problem has received only fragmentary scientific attention so far, in spite of the rapid increase in the number of citizens with clinical disabilities, the risk of which is quite high in patients with hysterical neurosis. This article introduces the clinical and socio psychological mechanisms that trigger the rigid patterns of neurotic hysterical personality development, as well as various therapeutic ways to overcome them. The study involved K. K. Yakhin and D. M. Mendelevich’s Questionnaire of Neurotic States, the Quality of Life Questionnaire issued by the World Health Organization, I. Ya. Gurovich and A. B. Shmukler’s Questionnaire for Assessing Social Functioning and Quality of Life of People with Mental Health Issues, N. G. Garanyan’s Emotion Recognition Test, N. S. Kurek’s Pose and Gesture Test, J. P. Guilford and M. O. Sullivan’s Social Intelligence Test adapted by E. S. Mikhailova. The empirical research revealed that the patients had an average level of quality of life because they needed constant psychiatric support and experienced problems at work and in private life. The patients also demonstrated a moderate decrease in social perception. The clinical symptoms prevented them from concentrating on perceptual elements, making them unable to understand the context and anticipate consequences. Their catathymic perception caused uncontrolled projections. However, patients with minimal deficit of social perception and intelligence, being active community members, were able to compare and critically assess their life situation. As a result, they expressed dissatisfaction with their well-being. Their deficient social perception chronicled neurosis; eventually, the patients accepted their clinical status, lowered their claims, and developed an uncritical positive assessment of life. The study revealed a strong feedback between the quality of life and social perception, which may help in psychotherapy and rehabilitation of patients with hysterical neurosis.

The historical connections between swimming and the art of war are unquestionable. The ability to swim is still valuable not only in the navy, which is quite obvious. Overcoming water obstacles requires the same from a soldier of the land forces, and special forces additionally teach efficient diving. During the Japanese Middle Ages, a samurai should, for a full education in martial skills (in Japanese: bugei), learn the rules of swimming in armour and with weapons (in Japanese: suei-jutsu) and acquire appropriate practical skills. Nowadays, in the practice of martial arts and combat sports, swimming is recommended as an excellent complementary sport. Are there other connections between the history, philosophy and cultural heritage of martial arts and swimming? In further analyses, concepts from the tradition of Japanese martial arts and references to several varieties of martial arts of Japanese origin will be used. The author presents here his own concepts resulting from his own experience, observations and conducted analyses.

Introduction and purpose Non-specific and specific lower back pain syndrome is one of the leading causes of musculoskeletal disability and affects more than half of the population worldwide. The aim of this paper is to confront the problem of lumbar pain, possible diagnostic options, conservative and surgical opportunities with long term satisfactory rate. State of knowledge The paper reviews literature on lower back pain syndrome, sciatica, radiculopathy and lumbar disc herniation in regards to detection of the problem, classifying it and possible methods of resolvement. The WHO defines lower back pain as one of the leading causes of musculoskeletal dysfunction and it focuses on reducing the occurrence by programs like WHO Rehabilitation 2030 Initiative, UN Decade of Healthy Ageing and others. The paper also focuses on non surgical options of treatment. Material and method A review of the literature available in the “PubMed” and Google Schoolar was conducted. We focused on differential diagnosis depending on clinical presentation and possible treatment methods depending on symptoms, pathogenesis of the disorder and available procedures. Summary Our review managed to present the current state of development, possible differential diagnosis, prevalence of neural compressions, sciatica and radiculopathy in different diagnostic options. By receiving multiple studies we confront varied opinions of specialists regarding the approach to lower back pain syndrome and favorable forms of care. Additionally we came to the conclusion that the difference of patients' long term satisfactory rate in regards to nonoperative and operative treatment is not significant, and flattens over the years.

Background. Neuropsychology and neuroscience solve a number of general issues concerning the relationship between brain and psyche, the principles of the structural and functional brain organization, the cerebral basis of mental processes, patterns of damage and recovery of complex behavioral systems. Neuroscientific basis for higher brain function recovery allows us to explain the regularities of neuroplasticity. The neuropsychological basis makes it possible to build an adequate programme of neuropsychological rehabilitation, taking into account not only psychological but also biological patterns. Thus, it is necessary to strengthen the integration of neuroscientific and neuropsychological points of views in this domain. Objective. The study aims to analyse the strengths and weaknesses of modular theory and the theory of system and dynamic localization of functions in solving the question of structural and functional brain organization and their reflection in approaches to neuropsychological rehabilitation. Methods. Comparative analysis and the method of generalization were applied. Results. Modular theory and the theory of system and dynamic localization of functions have a number of common key points. 1. The principle of the system (distributed) organization of higher cortical functions. 2. Horizontal-vertical structure of higher brain functions. 3. Сortical function is the constellation of factors/modules. 4 Functional unit (factor/module) is a structural element of different brain systems. 5. Damage of a functional unit leads to a selective damage of a certain group of cognitive processes. Theories differ in understanding the content of a functional unit of a brain, which leads to differing understandings of the typology in the ways to recovery. The study considers the role of subcortical structures in providing behavioral automatisms. The paper shows the importance of the intact conduction pathways in making rehabilitation prognosis. Conclusion. The study reveals limitations of the concept of factor in explaining the variability and dissociative picture of a neuropsychological symptom. The content of factor as well as its structural elements are to be revised and described. Certain statements of the theory of system and dynamic localization of functions have to be modified in order to reflect the regularities of neuroplasticity in the methodology of neuropsychological rehabilitation.

A systematic analysis of scientific research devoted to the study of neuroprotective properties of xenon was carried out to determine the possibility of its use for the protection of neuronal tissues in various pathological conditions and neurodegenerative disorders. The search was carried out in freely available scientometric databases, such as PubMed, Google Scholar, Web of Science, Scopus, etc. The criteria for inclusion in the analysis were publications that discussed the role of xenon in the protection of neuronal tissues, studies of the neuroprotective properties of xenon in animal and cellular models, clinical studies demonstrating the neuroprotective potential of xenon in available English-language sources. The literature was analyzed to identify key findings, research methodology, and outcomes related to the neuroprotective properties of xenon. This included an analysis of research methods, models used to assess the impact of xenon on neuronal structures, and the volume and quality of the data obtained. In addition, the pharmacological properties of xenon are considered, in particular, its physicochemical characteristics, mechanisms of action at the molecular level, and pharmacokinetics. The results of studies of the influence of xenon on the state of vascularization of the brain after after traumatic brain injury and the potential of xenon to prevent further injuries are presented. Studies evaluating the effects of xenon on neurological deficits after ischemic stroke and its potential efficacy as an anti-inflammatory and neuroprotective agent are discussed. The effect of xenon on the white matter of the brain in patients with aneurysmal subarachnoid hemorrhage and its potential to reduce damage are highlighted. Research data on the use of the liposomal form of xenon to improve the condition after a stroke, mental health, and the effect of xenon on the intestinal microbiota were analyzed. The results of studies on the effectiveness of repeated injections of xenon to improve sensorimotor and neuropsychic functions in patients after a stroke, as well as the use of xenon as one of the components of intensive therapy for alcohol poisoning and the potential advantages of such an approach are presented. Based on the analysis of literary sources, it was concluded that xenon is a promising tool for protecting brain structures in traumatic injuries and ischemic lesions, which improves rehabilitation. It reduces inflammation and increases the integrity of the blood-brain barrier, which helps restore brain function.

Aim: to evaluate the effectiveness of the developed program of hand therapy on the parameters of upper limb motility in wounded military servants with the consequences of a gunshot polystructural forearm bones fracture in the post-immobilization period Materials and methods. 49 military servants with the consequences of a gunshot polystructural forearm bone fractures were examined. The control group (23 persons) underwent rehabilitation according to general polyclinic principles. The main group (26 persons) underwent rehabilitation using tools and principles of hand therapy (therapeutic exercises and functional training for the wrist and fingers, forearm, shoulder, all joints of the upper limb, exercises on the mechanotherapeutic table MAPS THERAPY; Proprioceptive Neuromuscular Facilitation, massage of the upper limbs; kinesiological taping; orthotics) lasting 1 month. The effectiveness of the program was evaluated by the functioning of the upper limb when performing the Action Research Arm Test and dexterity by the Nine-hole peg test. Results. In the injured persons with the consequences of a gunshot polystructural fracture of the bones of the forearm in the post-immobilization period, deterioration of the motility of the upper limb according to the Action Research Arm Test and dexterity according to the Nine-hole peg test, which are factors of disruption of the normal functioning of the upper limb, were determined. After the rehabilitation intervention, all examined persons showed an improvement in motility according to the Action Research Arm Test in the control group by 14.7%, in the main group by 35.4%, according to the Nine-hole peg test - by 61.8% and 22.3%, respectively. According to all studied parameters, the patients of both groups showed a statistically significantly better result compared to the initial data (p

The research goal is to analyze the data on the organization and level of improvement of playgrounds with an inclusive component located on the territory of three large multifunctional parks in Moscow received from respondents to develop guidelines for organizing children’s inclusive playgrounds in large cities. The current research relevance is due to the fact that in Russia, until recently, children with health limitations were isolated from communication with peers and other people due to the fact that in society they were perceived as children with special needs. Therefore, it was believed that such joint communication is harmful to their health and development, and such children should be under constant supervision and attention from parents, guardians, and professionals. In connection with the mentioned opinion, they attempted to isolate children with disabilities from society, place them in special institutions, and teach in correctional schools. By virtue of rich global experience, this position has changed in Russia, and this category of children, now gradually transferred to ordinary schools with an inclusive component, has ample opportunities to develop both physically and psycho-emotionally, along with normally developed children. The research tasks include studying the organization of playgrounds intended for children’s recreation in such a way that all features of the psychological and physical condition of children with health limitations are fully taken into consideration. The possibility of the joint stay of children with normal development and children with health limitations within the same playground and their joint cognitive activity and various activities is also studied by means of conducting a survey. With the help of the developed questionnaires and visual material for children, a survey method is applied, implying surveying children, their parents, and guardians. The survey is conducted on the territory of children’s inclusive playgrounds in three large park areas of the city of Moscow. The survey goal is to study the psycho-emotional impact of landscape factors, urban greening, and the level of improvement, design, and construction of inclusive playground equipment on children with health limitations through outdoor games. The research results can be applied in practice in the organization and improvement of new inclusive playgrounds in city parks. Simultaneously, one should take into consideration their accessibility for people with limited mobility and the safety of structures and equipment.

The aim of the study was to evaluate the effectiveness of the influence of the developed program of physical therapy on the parameters of the geriatric status of elderly patients with motor consequences of total knee arthroplasty in the long-term period after surgery. Material and methods. 80 elderly people were examined. The control group consisted of 24 people without joint endoprostheses with no signs of geriatric syndromes. The comparison group consisted of persons with a knee joint endoprosthesis and sarcopenia with low rehabilitation compliance with respect to rehabilitation intervention. Representatives of the main group with a knee joint replacement and sarcopenia were engaged in a physical therapy program using functional training on the Prosedos platform, therapeutic exercises, massage, kinesiology taping, nutrition correction, and patient education. The effectiveness of the program was evaluated by the dynamics of the Senior Fitness Test, Tinetti-test (Performance-Oriented Mobility Assessment), Geriatric Depression Scale, Tampa Kinesiophobia Scale. Results. The geriatric status of the examined patients was characterized by muscle weakness (statistically significant lag in parameters of physical status - coordination, static and dynamic balance, strength, flexibility, endurance, dexterity compared to their peers according to the Senior Fitness Test, Tinetti-test), high risk of falling, kinesiophobia and psycho-emotional depression, which increases the risk of loss of autonomy and death. The developed program of physical therapy revealed an improvement in the condition of the patients of the main group due to the influence on the links of the pathogenesis of geriatric syndromes due to the improvement of balance and gait parameters, reduction of the risk of falling and fear of movements, improvement of the psycho-emotional status in comparison with the initial indicators in all studied parameters (р

AIM. To assess the degree of change in functional and biomechanical characteristics of the shoulder joint in patients with rotator cuffinjury.MATERIAL AND METHODS. The study included 119 patients, 59 patients with rotator cuff injury and 60 practically healthy volunteerswith no history of injuries and shoulder disorders, aged 18 to 66 years. All patients completed DASH questionnaires and underwentclinical examination by a traumatologist, neurologist and physical therapist, as well as a biomechanical examination of the shoulderjoint. The biomechanical parameters of the shoulder joint were studied using the «Con-Trex MJS» (Physiomed, Germany) computerizedisokinetic dynamometer. We chose the inward/outward rotation test as the diagnostic test. The inward/outward rotation test wasperformed lying on the back. The elbow was bent at an angle of 90º, the upper limb was moved 90º at the shoulder joint. The handle ofthe dynamometer was set individually according to the patient’s limb length. The axis of rotation of the dynamometer coincided withthe axis of rotation in the shoulder joint. The maximum allowable amount of motion in the test was limited to 90º movement of theexternal rotation and 80º internal rotation. The neutral position of the shoulder joint retraction equal to 90 ° and the elbow joint flexionat 90 ° were taken as the zero point of reference.RESULTS AND DISCUSSION. Patients with rotator cuff injury have a high shoulder pain level, 6.00 [5.00;7.00] VAS, a severe degree offunctional limitations 63.33 [55.92;66.67] scores on the DASH questionnaire, a pronounced decrease in shoulder range of motions, aswell as a significant deficit in dynamic strength and endurance indices and muscle performance.CONCLUSION. Patients with shoulder rotator cuff injury experience extensive functional limitations expressed in a high level of pain inthe shoulder joint, high points of the questionnaire of the upper limb functioning (DASH, more – worse) and a significant decrease inthe biomechanical indicators of the shoulder joint and upper limb in general, which ultimately leads to a serious limitation of functionalactivity, a decrease in the working capacity and, consequently, a decrease in the quality of life.

INTRODUCTION. The article reflects long-term and distant consequences of antitumor therapy, from three to six months from thebeginning of treatment, in patients with breast cancer. Analysis of the identified effects allowed to determine the structure of therehabilitation diagnosis based on the International Classification of Functioning.AIM. To designate the main International Classification of Functioning codes for breast cancer patients corresponding to the third stageof rehabilitation, to evaluate the effectiveness of rehabilitation measures at this stage of rehabilitation in breast cancer patients whoreceived different methods of treatment for this disease.MATERIAL AND METODS. The study was conducted on the basis Federal Research and Clinical Center of Radiology and Oncologyof the Federal Medical and Biological Agency of Russia for the period October-January 2021-2022, including the data analysis of 40patients (all women) with breast cancer stages I-IV, being at the third stage of rehabilitation 3-6 months after the complex antitumortreatment with the persistence of adverse events due to the therapy, the mean age of patients is 58 .6 ± 1.2 years.RESULTS AND DISCUSSION. The need for rehabilitation measures in patients with breast cancer persisted and increased after the endof antitumor treatment. A brief set of International Classification of Functioning was formed on the basis of complaints and evaluationof patients admitted to the third stage of medical rehabilitation from the standpoint of a biopsychosocial approach. Rehabilitationdiagnosis distinctive features were identified and, accordingly, the rehabilitation program was developed at the third stage of medicalrehabilitation of patients with breast cancer.CONCLUSION. The results of the study confirm the long-term effects of antitumor treatment, which suggests the need for rehabilitationmeasures to prevent the development and progression of complications and to improve the quality of life of breast cancer patients.

AIM. To evaluate the effectiveness of the comprehensive rehabilitation program for patients with rotator cuff injury using virtual realitytechnology.MATERIAL AND METHODS. The study examined 59 patients, 29 (49.2%) male and 30 (50.8%) female, the average weight was 79[70.00;87.50] kg, the average height was 1.72 [1.63;1.78] m, the average age was 48 [32.00;54.00] years, randomly divided into twogroups. The control group consisted of 30 patients, including 16 men and 14 women, the average age was 47.00 [27.00;54.00] years,the average height and weight were 1.71 [1.63;1.78] m and 77.50 [70.50;88.25] kg, respectively. Patients of the control group receiveda standard rehabilitation methodology. The study group consisted of 29 people, 13 men and 16 women, mean age 48 [39.50;56.50]years, mean height 1.72 [1.62;1.78] m, mean weight 81.00 [70.00;86.00] kg, who received classes with the inclusion of virtual realitytechnologies against the background of the standard method.RESULTS AND DISCUSSION. The study showed a positive dynamics of pain syndrome, an improvement of the functional state of theshoulder joint according to the results of the DASH questionnaire, an increase in the volume of the shoulder joint motions. The averageindicators of dynamic strength and muscular endurance and performance in the “inward/outward rotation” test increased by 58% and68.5%. In the “ adduction/abduction” tests, the strength indicators of patients with rotator cuff tears increased by 67.5%, and muscleendurance and performance by an average of 82.3%. According to the results of isokinetic testing, the growth of strength values in the“extension / flexion” test was 64.5%, and muscle endurance and performance were 79%.CONCLUSION. The inclusion of virtual reality technologies at the stage of medical rehabilitation of patients with rotator cuff injuriescan significantly reduce shoulder pain, improve upper extremity functioning, increase joint range of motion, and significantly improvestrength, muscular endurance and performance.

Background. Genital prolapse dramatically affects the quality of life of patients. Various sources show that the relapse rate after surgical treatment is 30 to 60%. Aim. To determine and compare the expression levels of collagen metabolism proteins before and after exposure to laser and radio frequency in the postoperative period in postmenopausal patients and to compare ultrasound elastography data to justify using these exposure methods as a rehabilitation program. Materials and methods. Histological specimens were collected from 54 patients with postmenopausal POP-Q grade 3 genital prolapse, and an ultrasound examination was made before surgery and after rehabilitation therapy. A real-time polymerase chain reaction method was used to assess the expression level of type I collagen, matrix metalloproteinases (MMP-2, MMP-9), and tissue inhibitors of metalloproteinases (TIMP-1, TIMP-2). Ultrasound examination was performed using the technology of compression elastography with the analysis of the color scale and the coefficient of tissue deformation. Results. Data were obtained on the increase in the expression of TIMP-1 by 7 times and TIMP-2 by 4 times in the radiofrequency therapy group compared to the group before treatment, as well as a 64-fold decrease in TIMP-2 expression in the vaginal tissue of women in the group after laser therapy compared to the group before treatment. A significant increase in the expression of TIMP-1 and TIMP-2 genes in vaginal tissue after radiofrequency exposure and a decrease in TIMP-2 after laser exposure demonstrate the compensatory effect of biological markers in response to energy therapy, as well as the remodeling effect of these methods. According to ultrasound, tissue elasticity in patients increased after laser and radiofrequency exposure. Conclusion. The results support using radiofrequency and laser therapy in the postoperative period as rehabilitation methods.

Despite the success of modern conservative therapy of severe spinal instability, surgical methods still retain their importance in the treatment of this pathology, but even the most successful operation may be in vain without subsequent adequate rehabilitation. This report summarizes the features of rehabilitation of patients after surgery for injuries of the cervical spine using methods and means of physiofunctional treatment.

Background. Acute cerebrovascular disorders are one of the main causes of severe disability in modern society. Russian and foreign researchers register the emerging trend towards rejuvenation of the patients with stroke, which, in turn, significantly increases the relevance of the treatment and rehabilitation of these patients at various stages.The aim. To study the social and hygienic characteristics of the stroke patients and to determine their need for medical rehabilitation in the early recovery period.Materials and methods. We studied the social and hygienic characteristics of 109 patients who had stroke in 2020 and 2021 and underwent rehabilitation in the specialized rehabilitation department of the Southern District Medical Center of the Federal Medical and Biological Agency, and determined their need for medical rehabilitation using the analytical method, the method of expert assessments and questionnaires.Results. The average portrait of a patient with a stroke in the early recovery period is as follows: this is a man aged 61 to 70 years with a higher or secondary specialized education, unemployed, living in the city. Up to 30 % of stroke survivors were recognized as disabled; among which, the persons with more severe disability (groups I and II) predominate – up to 90 %. Implementation of rehabilitation measures in the acute period in the hospital and in the early recovery period in the outpatient clinic is carried out at a fairly low level. The percentage of patients being examined by a multidisciplinary rehabilitation team ranges from 17.4 to 10.1 %.Conclusion. The availability of medical rehabilitation measures in a specialized rehabilitation center is quite limited; more than half of the surveyed contingent (52.3 %) experienced problems in obtaining a referral to treatment, about half of the respondents (46.8 %) waited up to 6 months for a referral, which indicates the need to expand the network of such institutions at the regional level.

Sports-related traumatic brain injuries (TBI) accounts for up to 20 % of all injuries that are obtained by athletes and its incidence rises annually due to rise in population involving in sports, growing popularity of extreme sports and high level of motivation to achieve record results among young sportsmen. The aim of the review is to present the potential benefits of using microwave radiothermometry and craniocerebral hypothermia technologies in sports-related TBI. The review considers most common form of traumatic brain injury in athletes - mild TBI, which in turn can provoke a wide range of complications and negative consequences in near and delayed periods after the injury. The main shortcomings of programs for complication prevention in treatment and rehabilitation of athletes after TBI are considered, which do not take into account the peculiarities of injury mechanisms, its significant differences from household, road or criminal injuries with brain damage. Lack of objective methods of instrumental diagnosis for injury severity is also described. In addition, pathophysiological component characteristics of sports TBI is accentuated: frequency of repetition, increasement of brain and body temperature, peripheral redistribution of blood flow and hypocapnia, which significantly affects cerebral blood flow. Based on the analysis of the available scientific literature, it is elicited that TBI is an independent cause of cerebral hyperthermia development, which significantly aggravates the consequences of the injury. Conclusions. The authors propose an innovative way to use microwave radiothermometry method as a diagnostic tool for sports-related TBI. In addition, the review highlights the main recommendations for complications prevention by using craniocerebral hypothermia technology, which reduces overall physical and cerebral hyperthermia, and augments the resistance of cerebral cortex neurons to hypoxia and trauma. However, the authors believe that the described approaches in sports medicine are not used purposefully due to lack of awareness of sports team doctors and coaches.

The article reviews the main complaints of patients with breast cancer depending on the type of antitumor treatment and defines thepeculiarities of the basic and additional sets of the International Classification of Functioning (ICF) codes.Aim. To present the clinical experience results of ICF use in making a rehabilitation diagnosis for patients with breast cancer, to discussthe issues and problems that arise when choosing domains in patients receiving various methods of treatment for this disease, to showby the example of a case report the use of ICF when forming a rehabilitation diagnosis in a patient with breast cancer after surgicaltreatment and anti-tumor drug therapy.Results and discussion. Patients who had undergone the surgical treatment, in the early postoperative period are predominantlycharacterized by: pain in the arm and shoulder joint, swelling of the arm, limited range of movement in the shoulder joint on theoperation side, increased fatigue, difficulties in self-care, irritability, and anxiety. Patients who had eceived radiation therapy complainedof skin manifestations – reddening of the skin in the area of radiation exposure and trophic ulcers, as well as complaints of numbnessof the fingers and toes, palpitations, a feeling of interruptions in the heart area, frequent changes in blood pressure, which arecharacteristic signs peripheral polyneuropathy and cardiovascular form of autonomic neuropathy. Distinctive features of patientshad being receiving anticancer medication therapy were complaints of disorders in the digestive system, hair loss. According to thecomplaints of each category of patients, the basic and additional sets of ICF were determined to make a rehabilitation diagnosis. Thecase report demonstrates the practical application of the basic and the inclusion of additional ICF sets for making a rehabilitationdiagnosis for a patient with breast cancer and determining the tactics of rehabilitative measures.Conclusion. The results of the study suggest the importance of reflecting the completeness of all domains of the ICF domains specificfor a particular patient, as the aim of rehabilitation is established on the basis of the rehabilitation diagnosis formulated by MDRTspecialists.

The problem of overweight (obesity) is steadily increasing.Aim. To evaluate the effectiveness of a new comprehensive rehabilitation program on the dynamics of weight and body compositionindicators using different methods after the rehabilitation stage and long-term results.Material and methods. Men and women aged 40 to 65 years with a body mass index ≥ 30 kg/m2 were included in the study. Thepatients were further divided into two groups by simple randomisation. Both groups underwent two weeks of medical rehabilitationon a low-calorie diet. The patients of the main group (group 1) received 4 methods of therapeutic physical exercises. Patients in thecomparison group (group 2) were treated only with aerobic exercise and therapeutic gymnastics. A dynamic observation was carriedout immediately after the course, after 3 and 6 months.Results and discussion. According to the data obtained, there was a significant reduction in body weight in both groups aftercompletion of the treatment phase, p=0.0001. There was a significant reduction in abdominal fat thickness after 14 days, 3 and 6 monthsin the main group (from 67.5[50.0;77.5] to 56.0[50.0;68.0] to 46.0[37.0;50.0] to 50.0[38.0;70.0] mm respectively). We obtained a significant(p

Aim. To evaluate the effectiveness and safety of aquatic training in diluted sodium chloride bromine brine in restoring the functionalstate of the organism of patients with portcovid syndrome in comparison with aquatic training in fresh water.Material and methods. Specialists of the National Medical Research Centre of Rehabilitation and Balneology of the Ministry of Healthof Russia conducted an open, prospective, randomized study to evaluate the effect of a course of aquatic training in a bromine sodiumchloride brine pool. The study included 28 subjects, who were divided into 2 equal groups. Patients in both groups were comparablefor gender (χ2 =0.45; p=0.31) and age (U=99.5; p=0.7) and all had post COVID-19 (U 09.9) as their primary diagnosis. The interventiongroup received a course of aquatic training (7 treatments) in a pool with bromine sodium chloride brine (well No. 69, 32 Novy ArbatStreet, Moscow) with mineralization of 120 g/dm3 and its preliminary dilution to 40 g/m3. Control group – a course of aquatic-exercises(7 treatments) in a fresh water pool. Patients, after signing informed consent, underwent load tests: 6-minute walking test, laser Dopplerflowmetry (“LASMA ST”, Russia), cardiointervalography (“Health Reserves-R”, Russia).Results and discussion. These data confirm the “null” hypothesis of a more favorable effect of the chemical composition of the dilutedbrine that acts during aquatic training on the patient’s body compared to fresh water, especially in the presence of microcirculationdisorders after suffering COVID-19.The group of patients who received aquatic training in the pool with bromine sodium chloride brine revealed a significant decrease inexcessive sympathetic nervous system activity (T-11.0; p=0.02) at the end of the study. According to LAZMA-ST data, there was a twofoldincrease in the oxidative metabolism of the cell (IOM T-16.0; p 0.05). These data confirm the “null” hypothesis of a more favorable effectof the chemical composition of the diluted brine that acts during aquatic training on the patient’s body compared to fresh water,especially in the presence of microcirculation disorders after suffering COVID-19.Conclusion. Aquatic training in sodium chloride bromide brine effectively reduces the sympathetic nervous system activity, increasesoxidative metabolism and improves microcirculation compared to aquatic training in fresh water.

To date, there are insufficient data on the concept of exploring rehabilitation potential in older patients with frailty syndrome, while developingstrategies to improve outcomes after cardiac surgery and reducing the number of postoperative complications remains a relevant topic.Aim. To assess safety and feasibility of early physical rehabilitation in frail patients undergoing coronary artery bypass grafting (CABG).Material and methods. The study included 49 patients with stable coronary artery disease (CAD) admitted for elective CABG withcardiopulmonary bypass (CPB). Patients were randomized into two groups according to the approach to physical rehabilitation: in theearly rehabilitation group (n=22), treadmill workouts were conducted starting from the 7th postoperative day and continued at thesecond stage of inpatient rehabilitation. Patients in the control group (n=27) had no treadmill training. In the inpatient rehabilitationsetting, the incidence and the type of complications were assessed; on the 6th day and 21-23 days after CABG, the results of thecardiopulmonary exercise testing (CPET) were analyzed.Results and discussion. The groups were similar in baseline intraoperative characteristics. Postoperative complications occurred in 18%of patients in the early rehabilitation group and in 48% of patients in the control group (p=0.037). In the group of patients with earlyrehabilitation, the rate of postoperative complications decreased by 4 times compared to the control group (OR – 0.24; 95% CI – 0.06-0.896). Peak oxygen consumption (p=0.03) and exercise tolerance (p=0.03) were significantly higher in the group of patients with theearly rehabilitation according to CPET conducted three weeks after the surgery. At the present stage, it seems optimal to shift the startof physical rehabilitation in postoperative period to the earlier dates. Minimizing the patient’s immobilization period helps to optimizethe course of the postoperative period.Conclusion. Early rehabilitation in the postoperative period of CABG in patients with frailty is associated with lower incidence ofpostoperative complications and improvements in physical capacity of patients by the end of the hospital stay.

At the present stage in the world there are many methods for restoring hearing in humans, but, unfortunately, not all methods are effective for high-grade hearing loss or deafness. Carrying out timely rehabilitation of patients with a deep degree of hearing loss, especially in childhood, is extremely important for social and psychological adaptation in society. In patients with severe hearing loss, cochlear implant surgery is the most effective treatment. This operation is possible while maintaining the anatomy of the inner ear and the conduction of the auditory nerve. This lecture details the general principles of rehabilitation of patients with hearing impairments of various etiologies, the tactics of selecting patients for cochlear implantation, which is of great importance for choosing a method for treating patients with hearing loss and their psychosocial adaptation.

Alzheimer's disease is the most common neurodegenerative disease in old age. In some cases, it is preceded by mild cognitive impairment (MCI). One of the important components in the pathogenesis of neurodegeneration is chronic neuroinflammation (inflammatory activation of microglia and astrocytes in the brain). Systemic inflammatory response and immune dysregulation may contribute to neuroinflammation. The purpose of this study was to investigate the level of chemokines and other inflammatory mediators in patients with MCI who underwent medical rehabilitation, and to study its associations with the severity of cognitive impairment. The study group included 48 patients with MCI undergoing rehabilitation. Rehabilitation included cognitive therapy, psychotherapy and tasks for unaided performance. Repeated examination was conducted 6 months after the completion of rehabilitation. The control group included 46 healthy volunteers. Multiplex assay was used to determine serum cytokine and chemokine concentrations. Student's t-test was used to assess the significance of differences. Assessment of cognitive functions was performed using international neuropsychological scales. In patients with MCI, we have found an increase in the levels of several cytokines and chemokines (TNFα, CXCL10/IP10, MDC) that regulate systemic inflammation, cellular and humoral mechanisms of adaptive immunity. After the rehabilitation course their levels returned to normal. It was also found that decrease in CCL7 level in the patients before the rehabilitation course is associated with the severity of cognitive impairment. The findings contribute to understanding the role of chemokines in the pathogenesis of MCI, and indicate that their levels can be potential biomarkers of the severity of cognitive impairment. For translation of the findings into clinical practice, their validation in larger studies is needed, as well as assessing the associations between chemokine levels and the severity of cognitive impairment in MCI over long-term follow-up.

The new coronavirus infection COVID-19, due to the complex pathogenesis of the disease, systemic impact on organs, the development of complications and persistent disorders after the infection, remains an important medical problem. Every year the number of patients with postcovid syndrome in need of timely and full rehabilitation is increasing. Recently, isolated work began to appear on the use of interval hypoxytherapy for the treatment of patients with coronavirus infection. The purpose of our study was to identify the long-term results of the effect of interval hypoxytherapy on the immunological and coagulation status of patients after suffering coronavirus infection COVID-19. 170 patients aged 45 to 59 years were examined after a moderate coronavirus infection before, after and three months after interval hypoxytherapy. The number of lymphocytes, immunoglobulins A, M, G, E and cytokines (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNFα) in blood, blood D-dimer, prothrombin time, fibrinogen in blood, antithrombin III, C-reactive was determined protein and ferritin in the blood. The conducted studies revealed changes in immunological reactivity after the coronavirus infection COVID-19, requiring correction. Interval hypoxytherapy had an immunomodulatory effect and led to the normalization of the main immunological parameters, which remained three months after hypoxytherapy: there was a significant (p < 0.05) increase in the number of CD3+T lymphocytes, CD4+T lymphocytes, CD8+T lymphocytes. The improvement in immune status was also evidenced by the normalization of the immunoregulatory index, an increase in the level of immunoglobulins A and G. The decrease in immunoglobulins E in the blood was an indicator of a decrease in the severity of sensitization of the body. The course of hypoxytherapy led to a decrease in the content of pro-inflammatory cytokines: IL-1β, IL-2, IL-6, IL-8, TNFα and an increase in anti-inflammatory cytokines: IL-4 and IL-10 in the blood, which indicated an attenuation of the inflammatory process in the lung tissue and in the body as a whole. Blood ferritin decreased 3 months after hypoxytherapy. As studies have shown, the effect of hypoxytherapy persists for three months after the course of treatment. Thus, interval hypoxytherapy can be recommended for the rehabilitation of patients after a moderate coronavirus infection. A repeated course of hypoxytherapy may be performed three months after the first course of hypoxytherapy.

The introduction of hybrid seedlings of cocoa by the Ghana Cocoa Board (COCOBOD) was intended to replace old and diseased trees which were less productive. We conducted a study to investigate the accessibility and use of hybrid cocoa seedlings (Series II, the Modified Series II, Inter Amazon, Trinitario, Clones, Criollo and Nacional) for the cocoa rehabilitation exercise. Working with 385 cocoa farmers selected from the Amenfi Central District using the multi-stage sampling technique, we analyzed the data with statistical tools such as the mean, standard deviation, frequency, percentage, multiple linear regression and chi-square test of independence. Based on the general perception of the cocoa farmers (PI=3.71), we found that they had positive perceptions of the improved hybrid cocoa seedlings. Cocoa farmers’ access to all the hybrid cocoa seedlings is significantly associated with their use (P