[Predictors of upper limbs' function in patients with cervical tetraplegia]. / Prediktory funktsii verkhnei konechnosti u patsientov s tservikal'noi tetraplegiei.

Patients with traumatic cervical injury of the spinal cord show clinical symptoms of tetraplegia. Furthermore, the motor function of the upper limbs is a key function for such patients, because it has a significant impact on the quality of life. One of the components of the definition of rehabilitation potential is the identification of the possible functions' ceiling and compliance of the patient's current condition with known model characteristics. OBJECTIVE: The aim of the study is to determine the predictors of upper limb functional motor activity in patients in the late period after spinal cord injury (SCI). MATERIAL AND METHODS: The study included 190 patients with SCI: 151 men and 49 women. The mean age of patients was 30.0±12.9 years, the age of SCI - 1.9 [0.60; 5.40] years, in 93% of cases SCI was traumatic. Patients were classified using the ASIA International Neurological Standard. Upper limb function was evaluated using a short version of the Van Lushot Test (VLT). Stimulation electroneuromyography (SENMG) from the median and ulnar nerves was performed. The distribution at the motor level (ML) was as follows: C4-C6 - 117 patients; C7-D1 - 73 patients; depending on the severity of injury (SI): type A and B - 132 patients; upper limb motor score (ASIAarm) was 25.0±12.2, on VLT - 38.3±20.9. The factor loading of 10 factors was evaluated simultaneously in a linear discriminant analysis, the cut-off point was 20 and 40 scores on VLT (25 and 50% on the International Classification of Functioning, Disability and Health without the domain «balance¼). RESULTS: According to SENMG, denervation changes were detected in 15% of median and in 23% of ulnar nerves. The rank significance for the VLT threshold of 20 scores was: ASIAarm - 100, functional tenodesis (FT) - 91, ML - 73, SI - 18; the classification tree had one branching at the ASIAarm point of 17.3 score. The rank significance for the threshold of 40 scores was: ASIAarm - 100, ML - 59, SI - 50, FT - 28, M response from the median nerve - 5; the classification tree had one branching at the ASIAarm point of 26.9 score. The results of multivariate linear regression analysis confirmed the highest factor loading of ML predictor, motor score for upper limb (ASIAarm) in both cases (R=0.67, R2=0.45, F=38.0, p=0.00 and R=0.69, R2=0.47; F=42.0, p=0.00, respectively). CONCLUSION: In the late period after a spinal injury the leading predicative value for functional motor activity has the motor score of ASIA for the upper limb. The ASIA score more than 27 scores is the prediction of moderate and mild impairments, and less than 17 - severe impairments.

[Patient-centered approach using COPM, GAS scores in medical rehabilitation of patients with tetraplegia after spinal cord injury]. / Patsientoorientirovannyi podkhod s ispol'zovaniem shkal COPM, GAS v reabilitatsii patsientov s tetraplegiei posle pozvonochno-spinnomozgovoi travmy.

OBJECTIVE: To study the efficacy of the patient- and task-oriented approach and specific therapeutic exercises (TE) for the arms in patients after spinal cord injury at the cervical level. MATERIAL AND METHODS: The study included 119 patients with a history of spinal injury of more than one year. They were divided into three demographically comparable groups. Group 1 patients (control) received standard of care: TE, physiotherapeutic treatment, social adaptation (SA), and massage; Group 2-standard of care and specific TE for the arms as part of the SA; Group 3-the same as Group 2 combined with the patient- and task-oriented approach (patient-selected activities were trained). Outcomes were assessed at the beginning (T1), end (T2), and at 1 year (T3) after a 30-day medical rehabilitation course. RESULTS: No statistically significant differences between the groups in demographic, neurological (ISCSCI score), motor (FIMm, VLT scores), psychological parameters (depression, anxiety), quality of life (WHOQOL-BREF score) before the medical rehabilitation (T1) were observed. At the end of the medical rehabilitation course (T2), the increase in functional scores was 6.0±5.4 points of FIMm score, 6.0±4.6 points of VLT score in group 1; 8.0±7.6 points of FIMm score, 7.0±7.1 points of VLT score in group 2; 9.0±6.9 points of FIMm score, 8.0±7.6 points of VLT in group 3. Significant differences were found between groups 1 and 2 and 3 on the domains of «finger I¼ (13.6±9.64 points vs. 15.2±9.40 and 15.3±9.21 points respectively), «fingers II-V¼ (9.4±6.76 points vs. 11.3±6.41 and 11.6±6.76 points respectively) of VLT score; between groups 3 and 1 on the domains «self-care¼ (25.9±9.67 points vs. 23.1±9.8 points), «transfer¼ (11.7±6.21 points vs. 10.6±6.1 points) of the FIMm score, and also the group 3 patients had a higher quality of life by 3.0±1.8 points. At delayed follow-up (T3-T2), no changes of the FIMm and VLT scores were detected within groups. In group 3, 69% of problems were identified in self-care (COPM); subjective assessment of functional improvement for COPM (T2-T1) was as follows: «performance¼ 4.7±1.27 points, «satisfaction¼ 3.8±1.63 points; for GAS the T-score at the end of rehabilitation was 1.3±0.55 points, and the greatest significance of change was noted for COPM under «performance¼ (ES=0.73), with the correlation coefficient between FIMm and COPM being 0.55 and 0.63 for «performance¼ and «satisfaction¼ domains, respectively. CONCLUSION: Patient- and task-oriented approach implemented by using COPM questionnaire and GAS score together with specific TE for arms is an effective method of motor medical rehabilitation of patients with posttraumatic cervical tetraplegia. This approach improves their quality of life, while parameters of subjective scores (COPM, GAS) have the same sensitivity in comparison with the conventional motor scores (FIMm, VLT).

[The use of electromyostimulation in motion in the treatment of post-traumatic edema of the ankle joint]. / Primenenie elektromiostimulyatsii v dvizhenii pri lechenii posttravmaticheskikh otekov golenostopnogo sustava.

Injuries of the ligamentous apparatus of the ankle joint are one of the most common injuries of the ODA. A large number of complications and a long period of disability require the development of modern methods of physiotherapy treatment that can reduce the number of relapses and reduce the duration of rehabilitation. OBJECTIVE: Evaluation of the effectiveness of the use of electromyostimulation in motion in the treatment of post-traumatic edema of the ankle joint. MATERIAL AND METHODS: 51 athletes with post-traumatic edema of the ankle joint were examined. The main complaints were the presence of pronounced edema in the area of injury, pain, restriction of movement in the joint. The patients were randomly divided into 2 groups: the 1st group (25 patients) received treatment with electromyostimulation in motion (while performing therapeutic gymnastics); the 2nd (control) group (26 patients) performed therapeutic gymnastics recommended for the treatment of patients with lymphovenous insufficiency. The method of laser Doppler flowmetry was used to study microcirculatory disorders in the area of injury. Peripheral hemodynamics was evaluated by the RVG method. The severity of edema was assessed by measuring the circumference of the lower leg in the lower third of the injured and healthy limb. The thickness of subcutaneous fat was assessed by ultrasound. The subjective feelings of athletes were evaluated using CIVIQ-2 questionnaires and pain syndrome assessment according to VAS. RESULTS AND CONCLUSION: The use of electromyostimulation in motion in patients with post-traumatic edema of the ankle joint helped to reduce pain, relieve soft tissue edema, increase the volume of movements in the affected joint, increase motor activity and improve the quality of life.

[Application of kinesis-taping and low frequency pulse magnetic therapy in medical rehabilitation of athletes with post-traumatic edema of the lower extremities]. / Primenenie kinezioteipirovaniya i nizkochastotnoi impul'snoi magnitoterapii v meditsinskoi reabilitatsii sportsmenov s posttravmaticheskim otekom nizhnikh konechnostei.

In the conditions of increasingly stringent anti-doping rules, the development of new non-drug methods of treatment and rehabilitation of athletes is of particular importance. OBJECTIVE: Development of new methods of medical rehabilitation of athletes after injury. MATERIAL AND METHODS: Thirty-three athletes with knee injuries were examined. The main complaints were the presence of pronounced edema in the area of injury. All patients were randomly divided into 2 groups: in group 1 (16 patients) lymphatic drainage kinesis-taping was performed; in the 2nd group (17 patients) - complex treatment including lymphatic drainage kinesis-taping and low-frequency pulse magnetic therapy. Using laser Doppler flowmetry a study of microcirculatory disorders in the area of injury was carried out. The severity of edema was assessed by measuring the circumference of the knee joint of the diseased and healthy limbs. The assessment of the subjective feelings of athletes using questionnaires CIVIQ2 andVAS. RESULTS AND CONCLUSION: Based on the obtained subjective and objective data, a medical complex was developed using lymphatic drainage kinesis-taping and low-frequency pulse magnetic therapy, which affects different steps in the pathogenesis of edema formation. Data obtained resultedin more pronounced positive effect during complex treatment compared with monotherapy with kinesis-taping.

[Upper limb motor and functional recovery in patients with tetraplegia]. / Vosstanovlenie dvigatel'nykh funktsii verkhnei konechnosti u patsientov s travmoi sheinogo otdela spinnogo mozga.

OBJECTIVE: To study the recovery of the upper limb motor function and functional independence in patients with cervical spinal cord injury. MATERIAL AND METHODS: The study included 49 patients with subacute tetraplegia, mean age 33±14.8 years, 42 men and 7 women, admitted to the Preodolenie Rehabilitation Center. The follow-up was up to 2 years. The clinical and functional states were assessed after 3, 6, 12 and more than 12 months after spinal injury, using the ASIA neurological standard scale, the motor subscale of Functional Independence Scale (FIM) and short form of Van Lieshout Test (VLT). All patients received continuous rehabilitation courses that included physiotherapy, occupational therapy, social support, psychological rehabilitation. RESULTS: Upper limb motor recovery occurred in the first 6 months after spinal cord injury at 5±3.9 points (ASIA), while in 49% patients motor level decreased by one segment of the spinal cord, in 8% patients completeness of spinal cord injury improved. The improvement of functional independence was found during the first 12 months: according to FIM, in the period of 3-6 months by 18±11.1 points, in the period of 6-12 months by 8±8.1 points; according to VLT in the period of 3-6 months by 19±14.4 points, in the period of 6-12 months by 5.6±6.02 points. CONCLUSIONS: Upper limb motor recovery mostly occurs in the first 6 months while the functional independence improvement lasts during the first 12 months after a spinal cord injury.

[Comparative analysis of functional independence predictors in patients with cervical tetraplegia]. / Sravnitel'nyi analiz prediktorov funktsional'noi nezavisimosti u patsientov s tservikal'noi tetraplegiei.

Purpose of the study was to investigate clinical predictors of functional independence in patients with cervical tetraplegia at different periods after a spinal cord injury (SCI). MATERIAL AND METHODS: 190 patients (151 men and 39 women) with an SCI from 3 months to 6 years old were included in a retrospective study. The average age was 27 years. The examination was carried out using the international standard for neurological classification of spinal cord injury (ASIA) with the definition of motor score ASIA for the upper extremity (ASIA upper extremity), neurological (NL) and motor levels (ML), and the completeness of spinal cord injury (AIS). Functional assessment was performed using the FIM motor subscale. The study of neuromuscular conduction of the median nerves - according to stimulation electroneuromyography (SENMG). The degree of functional independence was assessed as a severe disability with FIM less than 42 points, mild and moderate - FIM 42 points or more. RESULTS: Using logistic regression analysis, it was found that in the first 6 months after SCI, the main predictors are ASIAupper extremity (AUC=0.84; X2=3.32; p=0.06) and NL (AUC=0.80; X2=2.96; p=0.09). When observed in the first 12 months, ASIAupper extremity (AUC=0.86) remains the leading predictor. Moreover, pronounced functional limitations can be predicted using predictors of ASIAupper extremity in 84.4% and completeness of injury (AIS) in 81.2% of cases, moderate and mild limitations - ASIAupper extremity in 81.4%, NL in 86.0% and functional tenodesis (FT) in 100% of cases. In the long-term period (more than 12 months), the exceptional predictive power of the predictor ASIAupper extremity (AUC=0.92) is noted both in the prediction of severe (82.5%) cases and moderate and mild functional disorders (91.8% of cases). In addition, in the SCI long-term period, the predictor AIS plays a significant role in severe disorders (in 82.5% of cases), and NL (88.2%) and FT (100%) - in moderate and mild disorders. The boundaries between functional groups according to functional independence in groups of 12 months and more than 12 months after SMT are presented: ASIAupper extremity 22.4 and 22.6 points, ML more than 6.5 and the presence of FT with a ML of more than 5.6, respectively. At the same time, the results of SENMG showed low predictive significance. CONCLUSION: Motor score ASIAupper extremity is a leading predictor in all periods after SCI, while completeness of spinal cord injury (AIS) more accurately predicts pronounced functional limitations, and ML and FT predict moderate functional limitations. The FT, a neurological level of C6 and higher, a motor score ASIA upper extremity of more than 22 points are criteria for achieving moderate functional independence.

[Funtional tenodesis as a predictor of functional outcome in patients with cervical tetraplegia]. / Funktsional'nyi tenodez kak prediktor funktsional'nogo iskhoda u patsientov s tservikal'noi tetraplegiei.

AIM: To determine the value of functional tenodesis (FT) of the hand as a predictor of the degree of disability in patients with cervical tetraplegia (CT) at different periods after a spinal injury. MATERIAL AND METHODS: We examined 190 patients (79% - men) with CT (92.5% of cases of traumatic origin) at the age of 27 [21.0; 36.0] years with a neurological level of CІІІ-DІ, and a share of complete motor damage (A - B according to AIS) 70%. The examination included determination of neurological, motor levels and completeness of spinal cord injury (according to ISNSCI), assessment of functional independence (FIM motor domain), FT of the hand, and the severity of contractures of the joints of the hand. Using logit-regression analysis, creation of contingency tables, ROC analysis, depending on the timing of spinal injury, 4 classification models were studied: Disease duration less than 6 months, assessment of the functional outcome 6 months after spinal injury (model A); disease duration less than 6 months, assessment after 12 months (model B); disease duration less than 12 months, assessment after 12 months (model C); disease duration more than 12 months, evaluation after more than 12 months (model D, primary one). RESULTS: FT developed in the first 6 months after spinal injury in 12 (24%) patients, in 6-12 months - in 15 patients (20%), in more than 12 months - in 1 (less than 1%) patient. The incidence of joint contractures of the hand in group A (20%) and C (24%) did not have a statistical difference (χ2=0.22; p=0.64). Hand contractures in the first 6 months were observed in 20% of patients, in the first 12 months - in 24%, more than 12 months after spinal injury - in 28% of patients. In model A, the FT sensitivity was 80%, specificity was 64%, AUC - 0.65; in model B - 85%, 36%, 0.36, respectively; in model C (log-regression χ2=19.1; p was not determined) - 69%, 100%, 0.59, respectively; in model D (log-regression χ2=55.3; p was not determined) - 65%, 100%, 0.71, respectively. CONCLUSION: FT and contracture of the joints of the hand form during the first year after the debut of CT. As a predictor of a pronounced limitation of self-care, the sensitivity of FT in the first 6 months after spinal injury was 80-85%, in the later period, the specificity of FT was 100%, and sensitivity was 65-69%; in general, the predictive power of FT was low (AUC 0.36-0.71) and increased with the assessment of the functional outcome in the period of more than 12 months after the injury.

[Use of enhanced external counterpulsation in the treatment and rehabilitation of patients with atherosclerosis obliterans of the lower extremity]. / Primenenie metoda usilennoi naruzhnoi kontrpul'satsii v lechenii i reabilitatsii patsientov s obliteriruiushchim aterosklerozom sosudov nizhnikh konechnostei.

BACKGROUND: Cardiovascular diseases occupy a leading place in the structure of morbidity in Russia and other developed countries of the world. AIM: To study the efficiency of using enhanced external counterpulsation in the comprehensive rehabilitation treatment of patients with stages I-IIB obliterating atherosclerosis of the lower extremities (OALE). SUBJECTS AND METHODS: A total of 68 patients aged 50 to 78 years with stages I-IIb oale in the presence of clinical symptomatology of arterial insufficiency were examined and treated. According to the method of treatment, the patients were divided into two groups: 1) 32 people received a standard drug therapy (a control group). 2) 36 patients had an enhanced external counterpulsation therapy cycle during the standard therapy (a study group). The frequency of characteristic complaints, pain-free walking distance, peripheral hemodynamics, and the ankle-brachial index (abi) were assessed. RESULTS: Posttreatment leg pain on walking persisted in 11 (30.6%) and 25 (78.1%) patients in the study group and in the control one, respectively; there were leg cramps in 9 (25.0%) and 14 (43.8%) people and cold feet in 5 (13.9%) and 25 (78.1%) patients, respectively (p<0.05). In the study group, the considerable increase in pain-free walking distance as compared to baseline values averaged 250±31.2 m (p<0.05), while that in the control group was only 64.5±25.1 m (p>0.05). The posttreatment increase in the leg and foot rheographic indices averaged 23.9 and 23.2%, respectively, in the study group and 11.9 and 12.3%, respectively, in the control group. The increases in abi in the anterior and posterior tibial arteries were 31.4 and 35.2%, respectively, in the study group (p<0.05), and 16.0 and 13.0%, respectively, in the control group (p>0.05). CONCLUSION: The findings suggest that the use of enhanced external counterpulsation in the combination therapy of patients with stages I-IIb oale is a clinically effective and safe treatment.

[Physical rehabilitation of the patients presenting with dorsopathies following decompression surgery in the lumbosacral spinal area].

The present study included 80 patients at the age varying from 24 to 59 years examined at different time (from 3 months to 3 years) after the surgical treatment of herniated intervertebral disks, mostly with clinical signs of L(v)-, S1-root radiculopathy. Coordination gymnastics included a complex of specific isotonico-isometric, isometric, and isotonic exercises designed to affect the deep stabilization system. The exercises were performed in five starting positions in a continuous mode with a small or medium amplitude of the movements synchronized with breathing. It was shown that coordination gymnastics in combination with magnetic therapy and iodine-bromine baths results in the statistically significant relief of pain syndrome (p<0.001) and formation of the muscular corset. Moreover, it increases stability of the vertebral column, improves its adaptation to physical activity, eliminates regional postural imbalance, and promotes formation of the proper movement patterns. Taken together, these effects constitute secondary prophylaxis of vertebrogenic pain syndrome and progressive degenerative changes.

[The effectiveness of endonasal electrophoresis of neuroprotective agents used in the rehabilitative treatment of the patients presenting with primary open angle glaucoma].

The objective of the present study was to estimate the effectiveness of the peptide drug cortexin used to treat primary open angle glaucoma. It was shown that endonasal electrophoresis of cortexin resulted in more pronounced positive changes in the dynamics of clinical, functional, perimetric, and electrophysiological characteristics compared with intramuscular administration of the same drug to the patients of the control group. This difference was apparent both immediately after the termination of the treatment and during the long-term follow-up.

[The results of the application of the pre-formed physical factors and neuroprotective therapy for the rehabilitative treatment of the patients with diabetic retinopathy].

To evaluate the effectiveness of the neuroprotective agent used to treat the patients presenting with non-proliferative diabetic retinopathy. The study included 114 patients (228 eyes) at the age varying from 42 to 70 who presented with diabetes mellitus and non-proliferative diabetic retinopathy. Three groups were formed depending on the mode of treatment. The patients in main group underwent endonasal electrophoresis of 0.1% semax preparation. Patients of the comparison group were treated with intranasal instillations of semax and those of the control group received only standard hypoglycemic therapy and treatment with Doxy-Hem. The patients of the first two groups showed positive dynamics of the studied functional characteristics (visual, perimetric, and electrophysiological ones). The most pronounced and long-standing (up to 12 months) positive effect on the visual function was documented in the main group. The results of the present study give reason to recommend the inclusion of endonasal electrophoresis in the combined rehabilitation treatment of the patients presenting with diabetes mellitus and non-proliferative diabetic retinopathy.

[The correction of cognitive and psychological disorders in the patients presenting with vertebrogenic pain syndrome].

The objective of the present study was the dynamic estimation of the intensity of pain syndrome with the use of a visual-analog scale (VAS), characteristics of the psychological status and cognitive disorders, quality of life, and brain electrogenesis in 50 patients presenting with vertebrogenic pain syndrome of lumbar-sacral localization. It was shown that long-standing pain syndrome plays the dysadaptive role, causes structural and functional changes in the central nervous system (CNS), and is responsible for psychoemotional and cognitive disorders. The introduction of transcranial stimulation in the combined treatment of such patients promotes correction and reversibility of the above disorders, enhances the efficacy of electrotherapy, and improves the quality of life in the subjects with vertebrogenic pain syndrome.

[Potential of combined physiobalneotherapy for the treatment of circulatory insufficiency in the vertebro-basiliar system].

The main causes of the development a nd subsequent chronization of circulatory insufficiency in the vertebro-basiliar system is the deficient blood flow in vertebral arteries (VA) resulting from extravasal effects of degenerative and dystrophic changes (DDC) in the cervical segment of the spinal column. The rehabilitative treatment of the patients presenting with these disorders including either radon or iodine-bromine baths in combination with low-frequency pulsed currents (LFPC) applied to the cervico-nuchal region was shown to produce a fairly good therapeutic effect. The proposed physiobalneological combination (radon baths + LFPC) proved more efficacious than treatment with iodine-bromine baths + LFPC for the patients with exacerbation of cervical dorsopathy. The latter combination gave better results when applied to the patients with circulatory insufficiency in the vertebro-basiliar system having the history of vegetovascular dystonia, craniocervical injury, and cervical dorsalgia.

[Analysis of the efficacy of low-frequency pulse therapy in the combination with radon baths for the treatment of patients with different variants of the clinical course of cervical dorsopathy].

The authors present the results of analysis of combined physiobalneotherapy in the patients with neurological manifestations of degenerative lesions in the cervical spine with special reference to the clinical form of the disease. The use of unified criteria for the assessment of cervico-brachial pain syndrome and clinico-neuropsychological status of the patients in conjunction with auxiliary research techniques made it possible to demonstrate the high efficacy of the treatment using low-frequency pulse therapy supplemented by the application of radon baths. The best therapeutic effect was achieved in a group of patients presenting with cervico-brachial syndrome treated during the periods of exacerbation of cervical spine osteochondrosis. A less pronounced positive effect was documented in the group having the recurrent clinical course of cervico-brachial pain syndrome due to degenerative and dystrophic lesions in the cervical spine and diskopathy. The difference between the responses of the two groups of patients can be accounted for not only by the severity of degenerative lesions in the cervical spine but also by the changes in their psychoemotional sphere.

[Nucleosome histones isolated from normal and tumor cells and the effect of bivalent metals on their conformation]. / Issledovanie nukleosomnykh gistonov, vydelennykh iz normal'nykh i opukholevykh kletok, i vliianie dvukhvalentnykh metallov na ikh konformatsiiu.

A change of the secondary structure of histones isolated from tumor cells was observed. This changed structure showed increased percentage of elongated left helix of poly-l-proline II type. It is concerned with an increased content of bivalent Ca++ and Mg++ ions.

[Ca2+, Mg2+, Zn2+ levels in histone fractions from normal and tumor cells]. / Soderzhanie Ca2+, Mg2+, Zn2+ vo fraktsiiakh gistonov normal'nykh i opukholevykh kletok.

Distribution of some bivalent cations (Ca2+, Mg2+, Zn2+) in histones isolated from healthy mice liver and ascitic hepatoma 22A cells has been investigated by atomic-absorption analysis. It has been shown that the content of these cations is higher in normal and diseased H3, H2B and H1 fractions and lower--in H2A; however, in the H4 fraction these metals are not detected. A significant increase of Ca2+, Mg2+ and Zn2+ levels has been established in ascitic H3, H2B and H1 fractions. An increase of bivalent cations (Ca2+, Mg2+, Zn2+) content in some histone fractions apparently is bound with the changes of histone--histone and histone--DNA interactions.