No abstract

Резюме. Мета: оцінити вплив вправ з глибоким диханням на рівень тривоги та депресії серед кардіохірургічних пацієнтів. Матеріали і методи. У дослідженні взяли участь 75 пацієнтів, котрим виконувалось кардіохірургічне втручання. Пацієнтів було випадковим чином розділено (у співвідношенні 1:1, метод конвертів) на контрольну групу (КГ, n=38) та тренувальну групу (ТГ, n=37). Перед операцією пацієнти отримували коротку консультацію фізичного терапевта щодо цілей та змісту фізичної терапії, алгоритму активізації після операції. Післяопераційний протокол передбачав ранню мобілізацію пацієнта та заняття з фізичним терапевтом. За необхідності (стан пацієнта, необхідність мотивації) кількість та/чи тривалість занять могла збільшуватися за рішенням фізичного терапевта. Для пацієнтів КГ респіраторна фізична терапія обмежувалася кашлем. Пацієнти ТГ додатково виконували дихальні вправи з глибоким диханням. Для оцінки рівня тривоги та депресії застосовувалася Госпітальна шкала тривоги та депресії. Результати дослідження. Відмінностей у антропометричних показниках, функціональному класі NYHA, часових показниках операції не встановлено. Відповідно до результатів першого анкетування, рівні тривоги та депресії не відрізнялися у КГ і ТГ: ±S для тривоги становили відповідно 7,68±3,89 бала і 6,48±3,25 бала (р=0,153), а для депресії 5,66±4,11 і 5,89±3,31 (р=0,787). Аналогічний висновок отримано й при порівнянні результатів груп заключного анкетування: тривога ‑ 4(1; 7,25) бала проти 5(3; 8) балів (р=0,263); депресія ‑ 4,74±3,25 бала проти 5,54±3,61 бала (р=0,314). Висновки. Позитивного ефекту від включення вправ з глибоким диханням до післяопераційної програми фізичної терапії на динаміку показників тривоги та депресії не встановлено.

The purpose of the study is to determine the current provisions on occupational therapy interventions for children with ASD, features of their practical implementation and effectiveness based on the analysis of research data. Materials and methods. This work is the result of the analysis of scientific and methodological developments on the practical implementation of occupational therapy interventions in terms of timing and scope, complexity and role of the family; comparison of research results, which are devoted to the study of the effectiveness of behavioral therapy and SI, as the main interventions of occupational therapists. Results. Early rehabilitation of a child with ASD contributes to the formation of the necessary skills in everyday life and communication. To date, the largest evidence base has been accumulated by intervention programs, which are based on the principles of improving parent-child relations and are aimed at developing social and communication skills. Occupational therapy in ASD is aimed at overcoming motor anxiety, disorders of large and fine motor skills, coordination of movements and ability to learn, speech. SI-based occupational therapy is used to improve the processing of sensory information, improve the efficiency of "registration" and modulation of the senses, as well as help in the formation of simple adaptive responses. The effectiveness of sensory and motor interventions is manifested in positive changes in the social interaction of children, purposeful play and normalization of sensitivity. Sensory interventions of occupational therapists can reduce maladaptive behavior, hyperactivity, as well as inhibit self-stimulation, stereotyped movements and improve attention. Researchers recommend that occupational therapists combine sensory interventions with functional tasks that help the child's practice in achieving the goal of the activity. Conclusions. There is a large number of approaches and techniques used in occupational therapy for children with ASD. Given the lack of evidence to determine the most effective of them, it should be noted that additional research is needed to address this issue

The purpose of the study: to analyze the results of studies devoted to the study of the effectiveness of the use of mobilization techniques in patients with adhesive capsulitis of the shoulder joint. Materials and methods. This work is the result of an analysis of studies devoted to the study of the effect of mobilization techniques as monotherapy and as part of a complex physical therapy on the range of motion in the shoulder joint, pain on the visual analog scale, and the shoulder pain and disability index. Results. Stretching exercises, pendulum exercises, various manual therapies, proprioceptive neuromuscular facilitation techniques, and muscle energy techniques are used in physical therapy for adhesive capsulitis. Analysis of the literature confirmed that mobilization is widely used in the therapy of patients with adhesive capsulitis of the shoulder joint. At the same time, the number of mobilization techniques, which are used in the form of monotherapy or part of complex treatment, is significant. There are quite a few types of mobilization techniques for adhesive capsulitis of the shoulder joint: angular mobilization; progressive mobilization; mobilization of the spine in combination with scapular stretching, angular and translational mobilization; high-intensity techniques based on the pain threshold; the Cyriax approach; Mulligan technique; Maitland technique. There are research results that indicate an immediate effect of intensive mobilization on the amplitude of passive abduction. A number of studies have established the advantages of end-range and intensive mobilization compared to mid-range mobilization. At the same time, studies were found that did not establish the advantages of mobilization over therapeutic exercises, and also established the advantages of therapeutic exercises without pain compared to a complex intervention that included exercises and mobilization with exceeding the pain threshold. Thus, the question of the intensity of mobilization, the level of pain during mobilization remains relevant. Results of literature reviews noted that the Kaltenborn technique shows better results after 2-6 weeks of therapy in reducing pain, improving range of motion and functional activity; that there is moderate evidence of effectiveness of mobilization methods in the short and long term; that the Maitland technique and combined mobilization are recommended for use. In the aspect of mobilization with adhesive capsulitis, there is a question of its direction (anterior or posterior) to improve the amplitude of external rotation. At the same time, the conclusions of the last systematic review of the effectiveness of conservative methods of treatment of adhesive capsulitis indicate that there is no reliable evidence that would convincingly testify to the superiority of one method of treatment of adhesive capsulitis over another. Conclusions. The results of scientific studies indicate different conclusions regarding the effectiveness of mobilization techniques. There are works that indicate both the advantages of mobilization in adhesive capsulitis of the shoulder joint and their absence. Undisputed strong evidence in favor of one of the mobilization techniques is also lacking. Mobilization techniques can be used in physical therapy for patients with adhesive capsulitis, but more research is needed to determine the most effective intervention.

Quality of life indicators are key in assessing the effectiveness of physical therapy now, as they reflect the physical, psychological and social functioning of the individual. Objective: to determine the dynamics of quality of life in outpatients with disorders of orthopedic profile during a course of physical therapy, depending on the type of attitude to the disease. Research methods: quality of life assessment was conducted using the internationally standardized Health Status Survey. Patient grouping was performed using the International Classification of Functioning and the method of determining types of attitudes to the disease. The obtained results were processed by methods of mathematical statistics. The study involved 113 patients who underwent a course of physical therapy at FESCO Medical Center during 2013-2015. Results. The analysis revealed a number of features of the dynamics of quality of life depending on the localization of damage to the musculoskeletal system and the type of attitude to the disease. In particular, among lower-impaired patients group with irrational attitude to the disease had worse dynamics in the scales “physical functioning”, “role limitations due to physical health”, “pain”, “vitality”, “mental health” and "physical status". Because the dynamics in the groups with irrational attitude to the disease were statistically worse in a significant number of indicators, no comparison of the final indicators with the groups of patients with the rational attitude to the disease was observed. Conclusion. The existence of statistically significant differences in the dynamics of quality of life among patients with orthopedic profile during physical therapy at the outpatient stage was confirmed, depending on the type of attitude to the disease. The results obtained should be considered to improve the physical therapy system and increase its effectiveness. This is necessary first of all for patients with irrational attitude to the disease, as a significant number of the studied indicators were worse in these patients, and also had less pronounced dynamics compared to patients with rational psychotypes. This requires identifying the characteristics of managing such patients and improving management in the physical therapy system.