Vol 25, No 4 (2022)

BACKGROUND: The evaluation of impaired functions in patients with cardiac diseases is traditionally based on the clinical signs of the disease and instrumental hemodynamic parameters, without affecting all other disorders that occur with this pathology. The International classification of functioning is based on the functioning of the patient in his/her environment; therefore, a consistent assessment of the entire complex of impaired functions of the patient is appropriate, allowing for a more accurate formulation of the goals of rehabilitation and controlling the main stages of rehabilitation.

AIM: To evaluate the International classification of functioning for assessing all impaired functions in patients with chronic heart failure.

MATERIALS AND METHODS: The study included 68 patients with decompensated chronic heart failure. The analyzed sample included patients with chronic heart failure stages 2B and 3 (NYHA classes III–IV). The average patient age was 63.9 years, and the average disease duration was approximately 7 years. The sample was predominantly men (66.5%). The etiology of chronic heart failure was represented by uncontrolled arterial hypertension (92%), post-infarction cardiosclerosis (74%), ischemic cardiomyopathy (25%), and chronic obstructive pulmonary disease (12%). Radiation diagnostic methods were used to confirm the severity of cardiac decompensation. The study assessed impaired functions in accordance with the domains of the International classification of functioning, mainly in “functions of the cardiovascular system”.

RESULTS: In this study, 68 patients had decompensated chronic heart failure stages 2B and 3 (NYHA classes III–IV). Group 1 included 40 patients, and group 2 included 28 patients. The instrumental examination revealed a more pronounced decrease in left-ventricular ejection fraction in group 1 compared with group 2 (42.8±4.4 and 49.2±5.6, respectively), showing a significant difference (p <0.05). Other hemodynamic parameters did not differ significantly in the groups. In the analysis of a basic set of the International classification of functioning domains for patients with chronic heart failure, the following domains turned out to be the most significant: heart function (b410), forced myocardial contraction (b4102); heart rate (b4100); blood supply to the heart (b4103); blood pressure functions (b420): increase (b4200), decrease (b4201), maintenance (b4202); functions of the respiratory system (b440) including the “respiratory rate” (b4400); additional functions and sensations from the cardiovascular and respiratory systems (b450-469); exercise tolerance functions (b455); water balance (b5450), including “water retention” (b45500), characterizing the presence of edematous syndrome; and muscle strength functions (b730). The indicated domains were also supplemented with Section d (activity and participation) — walking long distances (d4501) and doing housework (d640); and Domain e (environmental factors), i.e., help from the next of kin (e310).

CONCLUSIONS: A set of domains of the International classification of functioning for patients with decompensated heart failure has been developed and proposed, which makes it possible to more effectively identify the key problems of people with disability and more objectively form a plan for complex rehabilitation, which largely determines the prognosis in these patients.

BACKGROUND: Down syndrome is a widespread, but still insufficiently studied genetic pathology, leading to early disability of the child population.

Complex habilitation using transcranial micropolarization according to the method of N.Yu. Kozhushko can effectively compensate for impaired cerebral functions. The article deals with the question of the expediency and relevance of the application of the International classification of functioning, disability and health ICF in the complex habilitation in Down syndrome in children, as an international language intended for a comprehensive description of the components of human health.

AIMS: studding the possibilities of transcranial micropolarization in the correction of neurological deficit in children with Down syndrome based on the principles of the ICF, designed to comprehensively describe the biopsychosocial status of a child.

MATERIAL AND METHODS: The study involved patients (n=55) with Down syndrome aged 3 to 5 years without severe concomitant decompensated pathology from other organs and systems. All cases of the disease were genetically confirmed: all had complete trisomy on the 21^st chromosome. The main group included 40 children, the control group — 15. In addition to the complex psychological and speech therapy support, the habilitation program for the children of the main group included the method of transcranial micropolarization according to the method of N.Yu. Kozhushko, the use of which can significantly improve the existing cerebral dysfunction in Down syndrome. All children were categorical ICF profiles, taking into account the most sensitive and informative in this disease.

RESULTS: According to the results of testing on a 10-point scale for assessing speech function, 6 months after the procedures, there was a significant improvement in the indicators of expressive and impressive speech, speech attention, as well as positive dynamics in the formation and improvement of neatness skills.

At the same time, the ICF made it possible to form a categorical profile of a child with Down syndrome, visually assess the influence of environmental and personal factors in each specific case, objectify changes in health disorders during habilitation, which is especially important in assessing the patient’s condition, developing a treatment plan, and analyzing the results obtained.

CONCLUSIONS: The method of transcranial micropolarization adapted by N.Yu. Kozhushko, can be recommended for complex habilitation for patients with Down syndrome. The use of the ICF for a comprehensive assessment of the functioning of a child with a hereditary disease makes it possible to take into account the strengths and weaknesses of the individual, correct environmental factors, which is especially important in achieving results in hereditary diseases accompanied by cerebral deficiency.

BACKGROUND: Assessment of the need for medical and social and long-term care for elderly and senile people serves as the basis for improving organizational approaches to improve the quality of medical and social services provided.

AIMS: Determination of the needs of elderly and senile people in the provision of medical and social assistance.

MATERIALS AND METHODS: For the study, a representative selective set of 400 elderly respondents is determined, of which 280 (70.0%) respondents lived at home (I group) and 120 (30.0%) — under the stationary conditions of the gerontological center (II group). The study was conducted by interviewing based on a specially designed questionnaire and «Loneliness» by Svetlana G. Korchagina. Statistical processing of the received data was carried out using the Microsoft Office Excel 2013 and statistical package Statistica 12.

RESULTS: The average age of the respondents was 72.9±7.96 years (p >0.05). The presence of polymorbidity was noted by every third respondent (33.0%), of which 2–3 diseases had 26.0%, 4 or more — 7.0%, with a prevalence in the structure of the incidence of diseases of the cardiovascular system. 53.0% of people are in need for medical and social home care. 31.0% of people were satisfied with medical care, 41.0% of people consider social assistance available. A high prevalence of the state of loneliness in elderly and senile people was established: 94.0% in group I, 99.0% in group II, with a progressive increase in the rate as the age of the elderly increases.

CONCLUSIONS: With increasing age, the subjective self-assessment of health worsens, associated with an increase in polymorbidity (mainly age-associated diseases) and the presence of disability; the decrease in the possibility of self-care increases the need for the elderly for assistance and care. The high prevalence of self-assessment of «loneliness» among the elderly and senile causes an increased need for older people in psycho-corrective measures.