Introduction. In valvular heart defects (VHD), expert assessment must consider not only clinical severity but also how cardiovascular dysfunction affects self-care, mobility, and work. Traditional methods inadequately reflect daily activity and social participation, so applying International Classification of Functioning, Disability and Health (ICF) domains as a framework for functional profiling is promising.Aim. To study the structure of functional limitations in disabled persons with VHD and identify expert-rehabilitation profiles based on ICF domains.Methods. A single-center retrospective cross-sectional study of MSE data from 2017–2024 was performed. First, the structure of limitations by categories and severity grades was analyzed. Second, in 557 examinees, associations between clinical-functional parameters and limitation grades were assessed, followed by ICF domain comparison and cluster analysis.Results. Among 13,652 disabled persons, grade 1 limitations predominated: self-care – 82.6%, mobility – 75.9%, work – 74.4%. Grade 2 limitations were most frequent for work (20.9%). Limitation severity correlated with chronic heart failure stage (χ²=462.2–890.8; p0.001) and NYHA class (χ²=333.7–545.5; p0.001). Grade 2 was associated with CHF IIB, atrial fibrillation, coronary disease, absent surgical correction, lower LVEF, and higher SPAP. Cluster analysis revealed three profiles differing in impairment severity and functional limitations.Conclusion.Functional limitations in VHD are multifactorial. ICF-based profiling enables a shift from isolated category descriptions to integrated profiles, facilitating structured assessment and rehabilitation planning.
BACKGROUND: Severe traumatic brain injury is one of the leading causes of severe disability in childhood. Post-traumatic changes in the emotional and personality sphere in adolescents significantly affect the quality of life of the child and family, as well as his/her socialization. However, the specific phenomenology and structure of emotional and personality disorders following severe traumatic brain injury in children, particularly in adolescence, remain poorly understood and understudied. AIM: To identify the structure of emotional and personality disorders in children who have suffered severe traumatic brain injury. METHODS: The present trial was conducted in the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma – Dr. Roshal’s Clinic in Moscow (2022-2025). 30 teenagers and adolescents, aged 12-17, with severe traumatic brain injury whose consciousness became "intellectually-mnestic insufficiency" within a year after injury. The diagnostic protocol included a clinical interview with parents, participatory observation of the child during a session, and projective techniques. The authors carried out a quantitative and qualitative psychological analysis using the identified criteria on impairments in the emotional and personality sphere. RESULTS: The following picture of negative symptoms severity in the children’s emotional and personality sphere was obtained. Formality dominated in contact (46.7%), less often - selectivity (16.7%) and refusal to interact (10%). At the emotional field, euphoric tendencies significantly prevailed (63.3%), less often - aggressive (26.7%), anxiety-phobic (20%) and dysphoric tendencies (16.7%). Impaired adequacy and congruence of emotions (53.3%) and emotional lability (63.3%) were often registered as well; less often - emotional flattening (26.7%). The most common behavioral disorders were involuntary behavior (50%), difficulty in maintaining boundaries (46.7%), and violation of rules of social interaction (40%). Aspontaneity (33.3%) and rigidity (16.7%) were less common. In the motivating field, there was no formed motivation for medical examination (50%) and no motivation for rehabilitation (63.3%); impaired volitional regulation (66.7%), decreased social activity (53.3%), decreased motivation for achievements (50%), non-selectivity (40%), narrowed leisure repertoire (66.7%). Also, high rates of uncriticism towards oneself (83.3%) and towards one's mistakes (67.7%). Based on the mechanisms of deficiency and perversions, a typology of disorders with leading radicals has been proposed: 1) Reduction of control and regulation; 2) Impoverishment of mental processes; 3) Distortion of control and regulation. CONCLUSION: The present trial is an attempt to identify criteria for assessing the emotional and personality sphere in adolescents as well as to identify the structure of defects in the emotional and personality sphere and several types of impairments that make child's socialization difficult. The obtained results have shown variability in the pattern of the emotional and personality disorders. The severity of various symptoms is a special task of psychological correction.
AIM: To assess the frequency of identification of impairments of body structures, body functions, activity and participation, as well as environmental factors, as described in ICF categories, by specialists of a multidisciplinary rehabilitation team within their respective competencies when formulating a rehabilitation diagnosis at the second stage of medical rehabilitation in patients with central nervous system disorders. METHODS: A retrospective analysis of 312 case histories of patients. For each patient, all the ICF domains used in the process of work were analyzed. The absolute frequency of occurrence of each domain was calculated, as well as the mean value, standard error, median, and interquartile range (IQR) to assess the contribution of each specialist. RESULTS: The most frequently identified domains were b760 control of voluntary movement functions (98.4%), s110 structure of the brain (98.4%), d4500 walking short distances (92.0%), and b770 gait pattern functions (89.1%). An analysis of the responsibility of specialists according to their competencies in the implementation of individualized medical rehabilitation programs based on the rehabilitation diagnosis showed that the largest share of tasks within individual programs related to patient domain structures is addressed by physical rehabilitation specialists, accounting for an average of 50.2% (95% CI: 48.7–51.8%) of all identified domains. The proportion of domains addressed by medical psychologists was 14.7% (95% CI: 13.5–16.0%); by speech-language pathologists — 6.6% (95% CI: 5.8–7.4%). The smallest contribution to the overall profile of functional impairments was made by domains related to impairments in daily activities — 1.5%. CONCLUSION: A high degree of standardization was identified in the assessment of motor impairments, whereas domains related to daily activity were used to a lesser extent. The obtained data may serve as a basis for optimizing multidisciplinary collaboration in the development of the rehabilitation diagnosis, as well as for developing a standard set of domains.
The legacy of the COVID-19 pandemic may represent an even more serious global health challenge than the acute infection itself. The neurological consequences of SARS-CoV-2 infection may progress to chronic brain tissue damage, leading to clinical manifestations of neurodegenerative diseases. Post-COVID-19 neurological syndrome and neurodegenerative disorders, such as Alzheimer disease and Parkinson disease, share common pathological features, risk factors, and underlying mechanisms. Immune-mediated mechanisms constitute a key component of the post-COVID-19 neurological syndrome and may initiate a neurodegenerative cascade. Chronic inflammatory processes triggered by SARS-CoV-2 infection promote the aggregation of misfolded proteins and neuronal loss, which are hallmark features of neurodegeneration. Given the high global prevalence of COVID-19 during the pandemic, health care systems should be prepared for a potential increase in the incidence of neurodegenerative diseases in the coming years. Addressing this challenge requires interdisciplinary collaboration integrating immunology, neurology, virology, and systems biology to develop effective individualized therapeutic strategies for one of the most persistent consequences of the COVID-19 pandemic. This review examines the complex relationship between COVID-19 and neurodegenerative diseases. SARS-CoV-2, its RNA, and proteins act as potent immunomodulatory agents capable of inducing chronic neuroinflammation even after viral clearance. Advances in modern biomedical technologies have enabled the identification of proteomic, genetic, and imaging biomarkers that may serve as predictors of risk and potential therapeutic targets. Elucidation of these molecular interactions provides important insights for future research aimed at developing innovative therapeutic and rehabilitation interventions.
BACKGROUND: The comorbidity of obesity and bronchial asthma is associated with mutually aggravating pathophysiological mechanisms, including adipokine imbalance, mechanical restriction of breathing, and reduced sensitivity to standard pharmacotherapy. Multidisciplinary rehabilitation is considered a promising approach, but its comparative effectiveness relative to diet therapy remains insufficiently studied. AIM: To evaluate the effectiveness of comprehensive rehabilitation (diet therapy combined with aerobic and strength exercises, as well as breathing exercises) compared to diet therapy alone in patients with obesity and bronchial asthma, based on the dynamics of anthropometric, biochemical, and functional parameters. METHODS: A controlled clinical trial was conducted. Forty women with grade I–III obesity were examined. The main group (n=20, obesity + bronchial asthma) underwent a 10–12-day comprehensive rehabilitation program including a standard diet, physical therapy, walking, bodyweight strength exercises, and breathing exercises. The control group (n=20, obesity without bronchial asthma) received only a reduced-calorie standard diet. Body composition (bioimpedance analysis), biochemical parameters, spirometry (forced expiratory volume in one second, FEV₁), functional tests (Stange and Genchi tests), questionnaires (Mini-AQLQ, VAS, Borg scale), the 6-minute walk test (6MWT), and International Classification of Functioning, Disability and Health (ICF) categories were assessed. RESULTS: Both groups showed significant reductions in body weight, fat mass, and total fluid (p 0.05). Skeletal muscle mass loss was 1.8% in the control group and 1.2% in the main group. Fasting glucose decreased by 9.7% in the main group (p 0.05) vs. 1.4% in the control group (p 0.05). Total cholesterol and low-density lipoproteins cholesterol significantly improved in both groups (p 0.05). In the main group, Stange and Genchi tests significantly increased, respiratory rate and VAS symptom severity significantly decreased, and the Mini-AQLQ total score significantly improved (p 0.05), while the 6MWT distance increased by 12.3%. ICF assessment confirmed improved respiratory function, physical endurance, reduced fatigue and dyspnea, as well as better dietary adherence and physical therapy performance. CONCLUSION: Comprehensive rehabilitation provides better preservation of skeletal muscle mass, more pronounced glucose reduction, and improved functional respiratory parameters compared to diet therapy alone. The obtained results justify the transition to a multidisciplinary approach in the treatment of patients with obesity and bronchial asthma, since only this approach allows simultaneous targeting of the metabolic, mechanical, and functional disorders characteristic of this patient category.
