Immunotherapy is becoming an increasingly popular cancer treatment method due to its high specificity and potential to be more effective than traditional approaches. The problem of the use of concomitant rehabilitation measures remains in the highlight, as they can help reduce unwanted side effects of the main treatment and improve the overall quality of life of patients. Purpose of the study. To expand the comparative analysis of the quality of life of patients diagnosed with melanoma and receiving immunotherapy, as well as the overall response rate during treatment with the use of accompanying rehabilitation magnetotherapy. Materials and methods. The study included 128 patients diagnosed with melanoma and receiving immunotherapy with pembrolizumab or nivolumab. The patients of the study group (n = 67) underwent a course of immunotherapy and an accompanying course of rehabilitation magnetotherapy. The patients in the control group underwent a course of immunotherapy without accompanying rehabilitation magnetotherapy. Treatment efficacy was assessed according to iRECIST 1.1 criteria. The EORTC QLQ-C30 questionnaire was used to study the quality of life. The degree of adverse events was assessed according to CTCAE 5.0 criteria. Results. The objective response rate in the study group (70.1 %) was higher than in the control group (65.6 %). Stabilization was the most frequent response to systemic treatment in most cases: 41.8 % in the study group and 49.2 % in the control group. In the study group, the improvement in the overall quality of life was more noticeable and amounted to 9.6 %, while in the control group, the improvement was at the level of 6.2 % (Т = 0.4, р = 0.023). Improvement in the general level of health was noted by 10.9 % in the study group and by 5.4 % in the control group (Т = 0.43, р = 0.015). Conclusion. The use of accompanying rehabilitation magnetotherapy during the course of immunotherapy led to an improvement in the overall quality of life of patients and a decrease in treatment side effects. Further research in this area is needed in order to determine the potential of magnetotherapy as an additional rehabilitation method.
The article presents the current data on the importance of applying a multimodal approach including hardware techniques with biofeedback in restoring fine motor skills of the hand in patients after ischemic stroke in the early recovery period. The results of the combined use of peripheral magnetic stimulation (Magstim Rapid) with active training on the Hand Tutor device with biofeedback are described on the example of a clinical case. The efficiency of the complex approach was evaluated according to basic scales of neurological deficit: the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale, the Barthel Index for Activities of Daily Living, the Rivermead Activities of Daily Living Scale, the Montreal Cognitive Assessment Scale (MoCA). We also performed a quantitative assessment of motor deficits in the affected limb before and after application of the technique, using the MediTutor software. Based on the results of the study, a decrease in both neurological and motor deficits in the affected limb was revealed; however, further study of the effectiveness of the method with the selection of parameters and duration of therapy is necessary.
The development of an effective and safe drug for the treatment of patients with COVID-19 is currently an urgent task for the global medical community. Given that lung damage remains the predominant syndrome in COVID-19, and the development of acute respiratory distress syndrome (ARDS) is the most common reason for transfer to intensive care unit and connection to artificial lung ventilation, it seems promising to study the effectiveness and safety of surfactant therapy, successfully proven in practice in the treatment of adult and preterm infants ARDS. Despite the fact that most studies are devoted to the use of this method in patients in the acute stage, we present a case from our own practice of Surfactant-BL inhalation in a patient with COVID-19-associated pneumonia at the 2nd stage of rehabilitation treatment. Clinical signs of respiratory failure (RR 22 per minute, Sa O2 86% on atmospheric air, 95% on insufflation of humidified oxygen 7 L/min), high percentage of lung tissue damage according to thoracic CT (55% – CT3) on admission to the Medical Rehabilitation Unit, as well as a score of 6 on the NEWS2 scale served as a basis for the patient to receive Surfactant-BL inhalation for the indication «prevention of the development of acute respiratory distress syndrome» in a dosage of 75 mg twice a day for 5 days. Positive dynamics of clinical data at the end of the course of inhalations (decrease of RR to 16 per minute, increase of Sa O2 to 90% on atmospheric air and to 95% on insufflation of humidified oxygen 5 l/min, improvement of auscultatory picture), as well as the control thoracic CT scan, which showed a decrease of lung parenchyma damage to 45.2% (CT-2), indicated the effectiveness and safety of this method in the complex rehabilitation of COVID-19 patient, being a basis for further investigation of this issue
The article presents the treatment data of 80 patients who had an ischemic stroke with movement disorders in the form of hemiparesis with increased muscle tone in the lower limb due to spasticity. The patients were divided into 2 groups comparable in terms of clinical and functional characteristics: group 1 included patients who, in addition to standard treatment, had gait adaptability training with video reconstruction on the C–Mill biofeedback system (BFB), and group 2 consisted of 40 people who underwent a course of standard drug therapy and medical rehabilitation (exercise therapy and medical massage). The characteristics of the main static and locomotor parameters were assessed according to the C–Mill data and the Tinetti assessment tool, and the range of motion in the lower extremities was assessed according to goniometry data at all control points (before and after treatment, 3 and 6 months after treatment). The obtained data indicate the benefit of including gait adaptability training in the standard complex of medical rehabilitation of patients who have undergone acute cerebrovascular accident with motor disorders in the form of hemiparesis with post-stroke spasticity of the lower extremity. This was confirmed by the normalization of the parameters of the gait adaptability, namely, a decrease in the duration of free gait (step cycle) by an average of 32 %, an increase in the frequency of a free gait step by an average of 30 % and in the length of a free gait step by 16 % immediately after treatment, with the results maintained at all control points.
To conduct a comparative analysis of the effectiveness of increasing functional capabilities in patients with a confirmed diagnosis of multiple sclerosis and moderate spastic hemiparesis as a result of a course of specialized training using the «Neurac» method. Material and methods. The study involved 20 patients who were divided into two groups. The first group (main) — 10 patients who underwent exercises on the Redcord suspension system using the «Neurac» («Neuromuscular Activation») method against the background of a basic rehabilitation course (therapeutic gymnastics with an exercise therapy instructor, mechanotherapy on a cyclic simulator, medical massage); the second group (control) — 10 patients who underwent exercises according to the basic rehabilitation course. The duration of the rehabilitation course was 14 days. Efficiency was assessed using the Berg balance test, the Barthel index, a 10‑minute test and the average walking speed on a treadmill with BFB C-mill (km / h). Results and discussion. A comparative assessment of the obtained results revealed that in both groups, compared with the initial data (44.4±0.5 points in the first group and 43.6±0.8 points in the second group), there was an improvement in balance (Berg balance test) to 48±0.3 points and to 45.3±0.5 points, respectively (p≤0.05). When assessing the Barthel index, a significant improvement in the indicators of daily activity was revealed in patients of the main group — 86.9 ± 0.5 points with initial parameters of 80.1 ± 0.7 points, which is significantly higher than in the control group (p ≤ 0.05) and when assessing the 10‑minute test — 16.82 ± 5.4 points compared to 26.3 ± 5.01 points in the control group (p ≤ 0.05), with initial parameters of 22.6 ± 3.33 and 28.3 ± 3.51 points, respectively. When assessing walking on the treadmill with BFB C-mill, the average speed (km/h) upon completion of the course was 0.90±0.1 (main group) and 0.84±0.3 (control group) (p≤0.05), compared with the initial data of 0.80±0.2 and 0.84±0.3, respectively. Conclusion. The obtained data indicate the high efficiency of the «Neurac» method in the rehabilitation of patients with MS, contributing to the improvement of balance in statics and in movement (in particular in walking), acceleration of walking, increase in functional capabilities, as well as the patient’s level of independence in everyday life.
BACKGROUND: Stroke in developed countries continues to be the most important medical and social problem and occupy a leading position in the structure of morbidity and mortality.
AIMS: To study the effect of the technique of robotic biomechanical rehabilitation on a sensory treadmill with built-in power platforms and biofeedback in patients with post-stroke spasticity on the main indicators of stride, cognitive function and psychoemotional status in the late recovery period.
MATERIAL AND METHODS: The study included 80 patients who underwent ischemic stroke with movement disorders in the form of hemiparesis with increased muscle tone by the type of spasticity in the upper and lower extremities in the late recovery period, who were divided into 2 groups: the control group ― 40 people, who received standard drug therapy and medical rehabilitation, including medical massage, exercise therapy and kinesitherapy, and the main group ― 40 people, who, against the background of standard drug therapy and medical rehabilitation, underwent training on a sensory treadmill with built-in power platforms and biofeedback. Objective indicators of step function, subjective indicators of cognitive impairment (Montreal Cognitive Assessment Scale, MoCA) and psychoemotional defects (Hospital Anxiety and Depression Scale, HADS) were assessed.
RESULTS: When analyzing the data after the course of treatment in the patients of the main group, the indicators of the parameters of the walking stereotype improved significantly compared to the data in the control group, the cognitive functions normalized, and the degree of psychoemotional defect decreased, which was confirmed by the MoCA and HADS scales.
CONCLUSION: The inclusion of training on a sensory treadmill with built-in power platforms and biofeedback in the standard complex of medical rehabilitation of patients who have suffered an ischemic stroke with movement disorders in the form of hemiparesis in the lower extremities in the late recovery period contributes to a significant improvement in the biomechanical indicators of stride, cognitive functions and a decrease in the degree of psychoemotional impairment.
To analyze the quality of life in patients receiving immunotherapy and overall response rate in case of additional magnetotherapy.The study included 3 cohorts of patients (n=48) with various disseminated malignancies (melanoma, lung cancer, kidney cancer) who received immunotherapy. In the study groups, all patients additionally took courses of rehabilitation based on magnetotherapy. In the control cohorts, patients underwent courses of immunotherapy without additional magnetic therapy. Treatment efficacy was assessed according to iRECIST 1.1 criteria. The Russian version of the EORTC QLQ-C30 questionnaire was used to study the quality of life. We analyzed adverse events using the CTCAE 5.0 criteria.In patients with melanoma, the most common response to systemic treatment was stabilization (41.7% in the study group and 30.8% in the control group). The objective response rate was higher in the study group (33.3% vs. 23.1%). There was also significant improvement in the quality of life after treatment in the study group (by 23.5%). In the control group, the indicator worsened by 4.8%. Overall health improved by 12.8% in the study group and 10.3% in the control group. In patients with lung cancer, response to systemic treatment with stabilization was achieved in 33.3% of patients in the study group and 20% of patients in the control group. The objective response rate was 33.3% and 20%, respectively. Analysis of the study group revealed improvement of overall health by 9.6% and overall quality of life by 38.6%. In the control group, overall health improved by 4.8% and quality of life remained the same. In patients with kidney cancer, the objective response rate was 40% and 42.9%, respectively. Disease stabilization was achieved in 40% and 28.6% of patients, respectively. Overall health improved by 16.7% and 6.3%, overall quality of life - by 19% and 9.1%, respectively.Magnetic therapy during the course of immunotherapy improved the overall quality of life and reduced severity of adverse events. Further study of magnetotherapy as an accompanying rehabilitation technique is required.Иммунотерапия является быстро развивающимся направлением лечения рака, благодаря более высокой специфичности и потенциально большей эффективности, чем традиционные методы. Остается актуальным вопрос использования сопроводительных реабилитационных процедур, позволяющих снизить степень нежелательных явлений на фоне основного лечения, а также улучшить общее качество жизни пациентов.Провести сравнительный анализ общего качества жизни пациентов, получающих иммунотерапию, а также частоту общего ответа при использовании сопроводительной реабилитационной магнитотерапии.В исследование были включены 3 когорты пациентов (48 пациентов) с различными диссеминированными злокачественными образованиями (меланома, рак легкого, рак почки), получающих иммунотерапию, которые были разделены на группы исследования и контроля. В исследуемых группах все пациенты дополнительно проходили курсы реабилитационных программ, основанных на магнитотерапии. Пациенты контрольных групп получали курсы иммунотерапии без дополнительной магнитотерапии. Оценку эффективности лечения проводили в соответствии с критериями iRECIST 1.1. Для изучения качества жизни была использована русская версия опросника EORTC QLQ-C30. Степень нежелательных явлений оценивали по критериям CTCAE 5.0.В когорте пациентов с меланомой самым частым ответом на системное лечение являлась стабилизация (41,7% в исследуемой группе и 30,8% в группе контроля). Частота объективного ответа была выше в исследуемой группе и составила 33,3% (23,1% в группе контроля). В исследуемой группе также зарегистрировано значительное улучшение качества жизни на фоне лечения — на 23,5% (в группе контроля ухудшение показателя на 4,8%), общего состояния здоровья — на 12,8% (в группе контроля улучшение на 10,3%). В когорте пациентов с раком легкого ответ на системное лечение в виде стабилизации был достигнут у 33,3% пациентов в исследуемой группе и у 20% пациентов в группе контроля. Частота объективного ответа в исследуемой группе составила 33,3% (в контрольной группе — 20%). Результаты опроса пациентов в исследуемой группе показали улучшение общего состояния здоровья на 9,6%, а общего качества жизни — на 38,6%. В контрольной группе улучшение общего состояния здоровья составило 4,8%, а показатели общего качества жизни остались на прежнем уровне. В когорте пациентов с раком почки частота объективного ответа составила 40 и 42,9% в исследуемой и контрольной группах соответственно. Стабилизация заболевания была достигнута у 40 и 28,6% пациентов соответственно. Улучшение общего состояния здоровья составило 16,7 и 6,3%, общего качества жизни — 19 и 9,1% в исследуемой и контрольной группах соответственно.Результаты применения магнитотерапии во время курса иммунотерапии показали положительные изменения общего качества жизни пациентов, а также снижение степени нежелательных явлений на фоне проводимого лечения. Требуется дальнейшее исследование магнитотерапии в качестве сопроводительной реабилитационной методики.
Background: Vertebrogenic disorders are among the most common chronic diseases in humans, with degenerative-dystrophic changes in the spine being the most prevalent. Severe clinical manifestations of vertebrogenic diseases typically occur during active working years and are a frequent cause of temporary disability. A particularly important issue is the need for regular rehabilitation courses for patients with chronic dorsopathy to prolong remission. However, due to the working-age status of many patients, logistical and paramedical challenges — particularly in implementing therapeutic exercises — often hinder access to rehabilitation procedures. The development of remote rehabilitation using information and communication technologies, such as smartphones and computers, presents a viable alternative to in-person rehabilitation. Aim: To assess the effectiveness and safety of motor rehabilitation using telemedicine in patients with dorsopathy of various localizations in remission. Materials and methods: This retrospective study included 32 patients aged 35 to 70 years with dorsopathy of various localizations in remission who underwent rehabilitation via telemedicine. Upon completing an in-person comprehensive treatment course which included pharmacotherapy and medical rehabilitation, all patients were provided with a link to access a structured motor rehabilitation program. The effectiveness of rehabilitation was assessed using standardized questionnaires and mobility assessment tests. Results: Telemedicine-based rehabilitation for patients with dorsopathy of various localizations in remission demonstrated positive clinical outcomes. Conclusion: Specialized therapeutic exercise programs and a structured model for remote rehabilitation may serve as an effective alternative to in-person rehabilitation, particularly in cases where paramedical challenges hinder direct participation.
In recent years, the improvement of the system of medical rehabilitation of patients with acute cerebrovascular accident has acquired special social significance due to the high morbidity.To study the effect of the combined use of a multifunctional platform and massage with a pulsed low-frequency electrostatic field on the motor functions of the lower limb, coordination and balance, as well as on the psychoemotional status and quality of life of patients after an ischemic stroke with hemiparesis in the late recovery period.The article presents data on the treatment of 120 patients who had an ischemic stroke with movement disorders in the form of hemiparesis with an increase in muscle tone by the type of spasticity in the late recovery period. All patients received standard drug therapy and underwent medical rehabilitation. The patients were divided into 3 groups: the main group - 40 patients who received massage with a pulsed low-frequency electrostatic field and training on a multifunctional platform with biofeedback (BFB) - COBS (mtd-Systems, Germany), a comparison group - 40 patients who received training on a multifunctional platform with biofeedback (BFB), control group - 40 patients.In the initial state, all patients included in the study showed an uneven distribution of the load in the protocols «normal standing position» and «standing balance» with an advantage towards the healthy leg. After the course of treatment in the patients of the main group, all the evaluated indices were normalized, in the patients of the comparison group statistically significant less pronounced results were obtained, and in the patients of the control group only a positive trend was noted. When studying the quality of life and the effectiveness of treatment according to the EQ-5D questionnaire in the examined patients in the initial state, the indicator averaged 7.8±0.8 points. After the course of treatment, the patients of the main group showed a statistically significant decrease in the indicators of the EQ-5D questionnaire from 7.8±0.8 points in the initial state to 5.1±1.1 (p<0.001), which lasted up to 6 months. In patients of the comparison group in all periods of observation, a decrease in the indicator was also noted, but less pronounced, in patients in the control group, only a positive trend. The data were supported by the Hospital Anxiety and Depression Scale (HADS) score.The use of complex rehabilitation with the inclusion of a multifunctional platform with biofeedback and electrostatic massage contributes to a pronounced improvement in the functional state of muscle tone, coordination and balance, a significant decrease in the level of anxiety and depression and has a pronounced positive effect on the quality of life and assessment of the health status of patients with hemiparesis in late recovery period after ischemic stroke.В последние годы совершенствование системы медицинской реабилитации пациентов при остром нарушении мозгового кровообращения приобрело особую социальную значимость в связи с высокой заболеваемостью.Изучить влияние комплексного применения многофункциональной платформы и массажа импульсным низкочастотным электростатическим полем на двигательные функции нижней конечности, координацию и баланс, а также на психоэмоциональный статус и качество жизни больных после перенесенного ишемического инсульта с гемипарезом в позднем восстановительном периоде.В статье представлены данные о лечении 120 больных, перенесших ишемический инсульт с двигательными нарушениями в виде гемипареза с повышением мышечного тонуса по типу спастичности в позднем восстановительном периоде. Все больные получали стандартную медикаментозную терапию и проходили медицинскую реабилитацию. Больные разделены на 3 группы: основную группу — 40 пациентов, получавших массаж импульсным низкочастотным электростатическим полем и тренировки на многофункциональной платформе с биологической обратной связью (БОС) — COBS («mtd-Systems», Германия), группу сравнения — 40 пациентов, получавших тренировки на многофункциональной платформе с биологической обратной связью (БОС), контрольную группу — 40 пациентов.В исходном состоянии у всех больных, включенных в исследование, отмечено неравномерное распределение нагрузки в протоколах «обычное положение стоя» и «баланс стоя» с перевесом в сторону здоровой ноги. После курса лечения у больных основной группы произошла нормализация всех оцениваемых индексов, у больных группы сравнения получены статистически значимые менее выраженные результаты, а у больных контрольной группы отмечена лишь положительная тенденция. При изучении качества жизни и эффективности лечения по данным опросника EQ-5D у обследованных больных в исходном состоянии показатель в среднем составил 7,8±0,8 балла. После курса лечения у больных основной группы выявлено статистически значимое снижение показателей опросника EQ-5D с 7,8±0,8 балла в исходном состоянии до 5,1±1,1 (p<0,001), которое сохранялось до 6 мес. У больных группы сравнения во всех периодах наблюдения также отмечено снижение показателя, но менее выраженное, у больных контрольной группы — лишь положительная тенденция. Данные подтверждались оценкой по Госпитальной шкале тревоги и депрессии (HADS).Применение комплексной реабилитации с включением многофункциональной платформы с биологически обратной связью и электростатического массажа способствует выраженному улучшению функционального состояния мышечного тонуса, координации и баланса, значительному снижению уровня тревоги и депрессии и оказывает выраженное положительное влияние на качество жизни и оценку состояния здоровья больных с гемипарезом в позднем восстановительном периоде после ишемического инсульта.
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