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Под повреждением спинного мозга традиционно понимают его поражение в результате травмы (например, дорожно-транспортной или при подводном плавании, падении с высоты, ошибке в ходе операции) или заболевания (атаксия Фридрейха, полиомиелит, онкологические процессы) [1]. Патогенез этого повреждения характеризуется уникальным сочетанием и динамическим развитием патофизиологических факторов и во многом обусловлен морфологическими изменениями различной степени выраженности [2, 3]. Позвоночно-спинномозговая травма (ПСМТ) -это неврологическое состояние, приводящее к постоянной или частичной потере моторной и сенсорной функций, соответствующих уровню спинного поражения [4]. Заболевание негативно сказывается на работе мочеполовой системы [5], желудочно-кишечного тракта [6], вегетативной функции [7] и зачастую приводит к спастичности [8], боли [9]. Пролежни мягких тканей возникают у 43-90% взрослых пациентов и являются одним из наиболее тяжелых и частых осложнений, развивающихся при ПСМТ [10]. Проблема реабилитации пациентов, перенесших позвоночно-спинномозговую травму (ПСМТ), является одной из самых сложных в системе мирового здравоохранения. ПСМТ влечет за собой тяжелые, стойкие функциональные нарушения, инвалидизацию, что обусловливает клинико-психологические, социальные, экономические проблемы пациентов. Изложены клинико-психологические представления и сведения, касающиеся проблемы адаптации пациентов с ПСМТ. Подробно описаны система поэтапной реабилитации таких пациентов, роль их личностных особенностей, а также социальных «провайдеров». Показано значение междисциплинарного сотрудничества при адаптации пациента к заболеванию. Ключевые слова: позвоночно-спинномозговая травма; адаптация; система реабилитации; здоровье; психология. Контакты: Мария Александровна Ярославская; visiteuse@mail.ru Для ссылки: Ачкасов ЕЕ, Ярославская МА, Машковский ЕЕ и др. Клинико-психологические аспекты реабилитации пациентов с по звоночно-спинномозговой травмой. Неврология, нейропсихиатрия, психосоматика. 2017;9(2):4-9. Clinical and psychological aspects of rehabilitation in patients with vertebral and spinal cord injuryRehabilitation in patients after vertebral and spinal cord injury (VSCI) is one of the most difficult problems in the global world health system. VSCI leads to severe, persistent functional impairment or disability, which causes clinical, psychological, social, and economic challenges faced by patients. The paper presents clinical and psychological ideas and information about adaptation problems in patients with VSCI. It describes in detail a stepwise rehabilitation system for these patients, the role of their personal traits, and social providers. The importance of interdisciplinary cooperation in patient's adaptation to disease is shown.Keywords: vertebral and spinal cord injury; adaptation; rehabilitation system; health; psychology. Contact: Maria Aleksandrovna Yaroslavskaya; visiteuse@mail.ru For reference: Achkasov EE, Yaroslavskaya MA, Mashkovsky EE, et al. Clinical and psychological aspects of rehabilitation in patients ...

Introduction. Health preservation for public health care workers, by means of psycho-rehabilitation programs managing stress in medical establishments, is a topical medical, psychologic and economic task.Objective. To study levels of emotional exhaustion, depersonalization and personal achievements reduction as psychologic burnout factors in workers of primary health care, depending on position and educational level, with specification of psychologic rehabilitation program and evaluation of its efficiency.Materials and methods. The study covered 137 female medical workers of outpatient departments in Moscow, with emotional burnout syndrome and length of service at least 5 years. Emotional burnout syndrome was assessed via a questionnaire «Occupational burnout» including 3 scales: «Emotional exhaustion» (1), «Depersonalization» (2) and «Personal achievements reduction» (3). 3 groups of the examinees were identified: group 1 — senior officers (15), group 2 — doctors (40), group 3 — nurses and paramedical personnel (82). All the examinees underwent 8 weeks of psychologic rehabilitation based on training of stress-resistance, personality development and relaxation methods.Results. Groups 1 and 2 demonstrated medium (scales 1 and 3) and high (scale 2) levels of emotional burnout syndrome, and the group 3 presented medium (scale 3) and low (scales 1 and 2) levels. All the groups responded positively on psychologic rehabilitation that decreased emotional exhaustion, increased responsibility for daily duties, improved and stabilized self-esteem.Conclusions. Manifestations of emotional burnout syndrome depend on peculiarities of medical workers’ occupational activities, position and educational level. Emotional exhaustion and depersonalization are more marked in senior officers and in doctors, than in nurses and paramedical personnel. Self-evaluation of occupational competence and activities is the same among all categoriesof the medical workers. psychologic rehabilitation enables to decrease symptoms of emotional burnout syndrome and is an important component of programs preserving working potential of medical establishments.

The purpose of this study was to assess the severity of the burnout syndrome components among health care professionals. 53 persons were included in the study: 23 doctors and 30 persons with specialized secondary medical education. Estimation of parameters of burnout syndrome was made using the Russian version of the questionnaire "Professional burnout" ("PB") by N. Vodopyanova and E. Starchenkova. In the result of the study it was found that the burnout syndrome develops regardless of age and professional experience of health care worker. A higher level of emotional exhaustion in women compared to men was detected. Professional achievements in men are evaluated as more successful, compared to women. The obtained results can be useful in the system of the development of psychologic prevention measures aimed at the preservation and maintenance of health in medical personnel.