Individual complex rehabilitation of psycho-neurological patients

Results have been analyzed of examination of 35 male patients aged 18-15 years. Of these, 25 presented with sequelae of closed craniocerebral injury (vegetovascular disorders presenting with rare epileptiform fits), 10 subjects--after having had their hematomas removed by endomicrosurgical techniques. All patients underwent computerized tomography of the brain and ultrasonic dopplerography of brain vessels. Shown in the paper is a high informative value of the above-named techniques in studying pathogenesis of intracranial hypertension, judging about the condition of brain tissue, liquor-containing and venous systems of the brain.

The monograph presents one of the fewest attempts to generalize the latest knowledge about apallic syndrome and persistent vegetative states. Unsuccessful resuscitation, new views’ representation of these states and the newest approaches to treatment are the most urgent problems of nowadays. Our eight-year experience of examining 43 patients in coma and with apallic syndrome, our successful arousing some of them from that condition, bringing them to the level of self-service and to social rehabilitation show that the brain does not die but it is in the state of persistent diashism. Someone may not believe in the possibility of not only long and permanent but also partial renewing effect in such cases; but we are talking about real people and their fates that changed for the better because of the optimism and diligence of doctors and patients and their relatives themselves. The authors are the doctors–neuropathologists who are proficient in methods of functional and radial diagnostics and they analyse the famous issues about this problem redoing them creatively according to their own experience of successful arousing patients from apallic syndrome. The edition is intended for doctors-resuscitators, neurologists, neurosurgeons, pediatricians, psychiatrists, and doctors of radial and functional diagnostics, students, internees and post-graduate students of medical institutions. CONTENTS Theme topicality Terminology Comatose states Pathological approaches to realising brain dysfunction In comatose states Apoptosis Brain death diagnosis: historical overview Bioethics aspects of the brain death diagnostics more details: http://lushchyk.org/en/apalitychnyj-syndrom/

Neurootological aspects of neurorehabilitation patients in apallic syndrome Babiy I.P., Lushchyk U.B., DM Contact address: Babiy Igor Petrovich Pochayninska Str.44a, 04070 Kyiv, Ukraine Ukrainian Scientific and Methodical Center of Ultrasound Medical Diagnostics “Istyna” е-mail: istina@voliacable.com Key words: apallic syndrome, neurorehabilitation, vestibular-cochlear nerve, nystagmus. Introduction In the sphere of medical care of the last decade a little-known state quite often occurs, which is introduced as apallic syndrome (AS) or vegetative state (VS) in the structure of diagnosis included in International Disease Classification – 10. In 1940 Е. Kretschmer firstly used a term “apallic syndrome” and gave the first full description of its clinical picture. This laid down the beginning to understanding of essence of this pathological state by next generations of physicians. (1, 3, 5, 6). Long-existing total disturbance of functions of the brain cortex is in the basis of AS. (1, 3, 5, 7). More often AS develops after serious brain injuries both of traumatic (car accident, gunshot wound etc.) and non-traumatic genesis (global cerebral ischemia as the result of heart arrest, respiratory standstill, asphyxia of various genesis, serious disturbances in cerebral circulation, infections of CNS, growth, endogenous and exogenous intoxication, degenerative and metabolic disturbances, failing in development). AS develops approximately in у 1-14% of patients, who are in long-term traumatic coma, and in 12% of patients, who are in coma of non-traumatic etiology, and it is connected with widespread structural damages of the cortex, limbic structures and basal kernels with the relative preservation of brain stem. (1, 2, 4, 6, 7). Actuality The urgency of the problem, connected with AS, is reflected first of all in the absence of an efficient system of treatment and adequate methods of control of such patients’ state. Objectives Objectives of the study: the search of ways for improvement of the multidisciplinary method of neurorehabilitation AS patients by means of efficient application of existing approaches in the field of neurootology Subject of the study On the basis of the Kyiv Scientific – Methodical Center of Ultrasound Medical Diagnostics “Istyna” and in resuscitation departments of medical institutions with different levels of submission 72 patients aged from 18 to 67 were observed, who after long-term coma (more than 2 weeks) came into AS. Anamnesis of the disease was from 2 months to 6 years from the time of verification. By the etiology patients in AS were divided into patients of traumatic (49 persons) and non-traumatic (23 persons) origin. Methods Every patient had clinical-neurological and instrumental examination (USDG, EEG, smart optic capillaroscopy). Neuroreabilitating treatment of patients in AS was performed in accordance with a patent of the State Patent Office of Ukraine „Way of neurorehabilitation patients in apallic syndrome” №72725 А on 31.12.03). According to the catamnesis every examined patient did not suffer from disturbance of hearing and vestibular apparatus. During neurorehabilitation peculiar features of restoration of vestibular-cochlear nerve’s functions were observed in every patient in AS. General duration of treatment of patients in AS is 3 years. Results On the stage of akinetic mutism the vestibular portion of VIII pair of cranial nerves in patients in AS received stimuli in the form of quick transferring of the patient from the horizontal position into sitting position by quick turning of his head or his body along longitudinal axis: nystagmus → vegetative storm → convulsive seizure. Criteria of presence of hearing in patients in AS: 1) the simplest vegetative reactions (reddening, blanching, sweating, widening of pupils); 2) Moving start-reflexes (muscle tension, starting, facial expression, turning of eyeballs or his head) to sound stimuli of the physiological level and higher; 3) activation of polymorphic EEG-curve. 100% of examined patients had signs of the hearing presence. Main directions of curation on the stage of “little” consciousness: -adequate hemodynamic correction with medicine mixtures -psychocorection -logopedic correction - physical loads and verticalization A stage of “high” consciousness provided with the possibility of direct participation of patients in the further training of the vestibular nervous system. Slow walking, turning movements, inclination by the head and the trunk were an independent work of 48 (66,7%) patients, who achieved the level of household self-serving and socialization. Walking, holding self-balance required external assistance. Hemodynamic medicinal correction on all stages of restoration of the vestibular functions in patients in AS was performed under hardware monitoring by USDG of the major vessels in the head and neck, EEG, smart optic capillaroscopy, which provided with an adequate hemo- and liquordynamic balance of the brain. Conclusions 1. The vestibular-cochlear nerve with its peripheral receptors is one of the most stable morpho-functional parts in the brain to the long-term hypoxic-ischemic lesion. 2. A long non-corrected disturbance of cerebral circulation in patients in AS causes deepening of dysregulation of vestibular-cochlear nerve’s functions and decreasing of threshold of response, which leads to slowing down of the neurorehabilitation process. 3. Restoration of the primitive vestibular functions in patients in AS has expressive positive dynamics and can be limited by more rigid hemodynamic adaptation to verticalisation and then by restoration of cognitive functions of the central nervous system. 4. Intensive medicinal therapy in neurorehabilitation treatment patients in AS, in particular for restoration of multilevel connections of VIII cranial nerve , must be based on the normalization of hemodynamic parameters both in major vessels and on the microcirculatory level and with intensive restoration of cognitive functions. 5. During performing training exercises for restoration of the multilevel connections of the vestibular part we must follow the direction from peripheral receptors, across internuclear connection of the brainstem up to cortical representatives. Perspectives In the light of the study there is a necessity in continuation of improvement of the medicinal and non-medicinal influence on restoration of the vestibular portion of VIII cranial nerve in patients in AS during neurorehabilitation for reduction of general terms of the curation. Reducing of hyperexcitability of the vestibular apparatus and prophylaxis of possible vegetative crisis are tasks on early stages of rehabilitation patients in AS. References 1. Апаллический синдром / Под ред. С.К. Евтушенко. – Донецк, 2000. – 20 с. 2. Бабій І.П., Лущик У.Б. Місце кінезитерапії та її особливості в комплексній реабілітації хворих з апалічним синдромом / Матеріали ІІІ Міжнародної науково-практичної медичної конференції “Сучасні тенденціїї застосування передових медичних технологій у клініці та в лікувальній практиці”. – К., 2003. – С. 3–7. 3. Лущик У.Б., Лущик Н.Г., Бабій І.П. Апалічний синдром. – К., 2003. – 73 с. 4. Омельяненко А.А. Клінічна картина та інструментальна характеристика апалічного синдрому в дітей та його лікування. – К., 2001. – 22 с. 5. Плеханова С.А. Персисирующее вегетативное состояние. // Неврологический журнал. – 1998. – № 4. – С. 16–21. 6. Jennett B. (2003) The Vegetativ State. Cambrige University Press. UK, pp.1–23. 7. S. K. Yevtushenko and A.A. Omelyanenko. 29 cases of non-traumatic apallic syndrome in children // Europian Journal of Pediatric Neurology. – V.3, № 3. – P. 53. Summary The study presents one of many problematic aspects of neurorehabilitation patients in apallic syndrome – neurootological one. Features of restoration of the vestibular function and this process’ dependence on hemodynamic correction are shown. Features of renewal of the vestibular part VIII of a pair of cranial-cerebral nerves in patients with apallic syndrome are covered. A dependence of efficiency of neurorehabilitation on severity and persistence of disturbances in vestibular apparatus and its polycyclic connections is determined.

Any convulsive reactions of the living organism have been of scientific-practical interest to researchers remaining one of the most serious reactions of the organism in a critical state. Therefore, today epilepsy and convulsive states remain less curable and taking anticonvulsant preparations is ineffective, as the living organisms reactions are not studied enough at any lesions of CNS. Appropriately, that the treatment result of such, probably nonlinear, reactions is directly related to understanding of pathogeny of origin and development of the convulsive component of reacting. Here are some aspects of algorithm of the convulsive reaction forming as a logical response of the living organism to an inadequate irritant. 1. The energy providing for the living system is subject to laws of energy conservation and transition of amount in quality and, depending on the state of the organism, can have nonlinear character. 2. Disproportional development of the child brain with the tessellated overexcitation of one area and expressed braking of the other cause a background hemodynamic-energy disbalance with the difficult forecast and modulated nonlinear dependences and numerous paradoxical reactions. 3. Motor non-control excitation in the form of partial or generalized cramps is actually a basic visual syndrome which accompanies the convulsive seizure and also is the reflection of nonlinear processes of excitation-braking and motor reactions. 4. Horizontal body position of a patient during the convulsive attack is hemodynamically reasonable by the necessity in leveling the pressures and hemodynamic-water balance in the organism and characterized by inadequate linear (horizontal-vertical body position) and nonlinear dependences (edema and blood supply decreasing). 5. Today an integrated objectivisation of a state of all systems in the brain (exactly the brain!) is urgently necessary under control of modern diagnostic equipment for adequate and accurate treatment tactics for patients with convulsive reactions, starting better from the phase of the disease debut. Therefore, application of dynamic theory of linear and nonlinear processes is extraordinarily actual in medicine and it is necessary for modeling of various pathological reactions of the organism for monitoring of etiopathological connections.

Scientific objectives Researches on brain functions, forming of algorithms of neuronets' functioning and attempt of their active correc-tion are priority in medicine. With IT medical technolo-gies the brain function research like EEG and transcranial electro-stimulation gains new significance and should be revised. Application of methodology for clinical interpreta-tion in the estimation of the brain bioelectric activity allows creating a universal technology for estimation and individually oriented monitoring and correction of brain functions with the purpose of improvement of neurone conductivity, reactivity of cerebral tissues to stimuli, balan-cing of excitation and inhibition processes [1]. Results interpretation During 17 years the Veritas Research Center has investi-gated sanogenic and pathological reconstructions in the brain bioelectric activity in patients of different type -from healthy to non-curable. 33% of all vascular patients were less curable (hemodynamically marked stenosises of the major arteries, combined cardiovascular insufficiency of II and III stages) and 48% of all psychoneurological patients (apallic syndrome, multiple sclerosis, lateral amyotrophic sclerosis, autism, ICP, epilepsy). The dynamics of brain bio-electric activity testified to large potential in functional activity of the brain, necessity in formation of new algo-rithms and IT-technologies for monitoring neurodynamics in the treatment process [2,3].

Scientific objectives Problems of psychoneurological patients' treatment always were and remain actual one as the nervous system's struc-ture is complicated and treatment results are sometimes unpredictable [1]. Today new knowledge and intellectual technologies enable to reconsider generally accepted approaches. Results interpretation The Veritas Research Center has made the comparative analysis of standard and multidisciplinary approaches to treatment of 724 psychoneurological patients, who were treated and rehabilitated in the Clinic of Healthy Vessels. 78% had psychosomatic disorders, 63% of cases required psychotherapy, 47% -psychocorrection, 38% -psycho-speech correction, 83% -motion disorders. 23% of patients had lasting patterns of psychological guidelines "on illness", aggravation, adjusting behaviour on the disease progress and block of the future vision. For the first month of treat-ment in the result of correction of the educed concomitant pathologies and rehabilitation the treatment effect has grown on 15-21% depending on the expressed psychoneur-ological lack. During the long-term rehabilitation for 3 months up to 1 year the treatment costs have reduced on 10-17% in comparing to standard approach and the treat-ment effect has grew on 75-83% [2,3]. For a year of the individually oriented multidisciplinary rehabilitation and treatment 84% of serious non-curable patients with apallic syndrome, ICP, epilepsy has reached 5 th score of the Ran-cho Los Amigos Scale from the lower level [2,3]. Outlook and expert recommendations According to the results of the conducted researches it is expedient to change the treatment algorithms for psycho-neurological patients with the purpose of more rational use of costs and reaching greater effect, bringing the ner-vous system on the autoregulation level and self-control of neuronets, renewal of self-service and capacity. References 1. Lushchyk UB, Novytskyy VV: Polyvector dynamic diagnostics of the vascular systems. A modern innovative medical technology: from local examinations to integrative comprehension of the whole system. Med Devices 2008, 3:64-67. 2. Lushchyk UB, Babii IP, Titenko TM, Novytskyy VV, Stukalin VO, Lushchyk NG, Leonova VV, Priz AM: Innovative vectors in neurorehabilitation. Logic and management of multidisciplinary approach in restorative medicine. In Macros. Volume 244. Kyiv; 2012. 3. Lushchyk UB, Novytskyy VV, Alexeyeva TS, Francevich KA, Branytska NS: Analytical aspects of an individual hemodynamic correction in the angioneurology.A95 Cite this article as: Lushchyk et al.: A project of harmonious health renewal in psychoneurological patients on the basis of the personalized algorithms for treatment and rehabilitation. EPMA Journal 2014 5(Suppl 1): A95.

INTEGRATED APPROACH TO DETECTION AND CORRECTION OF VASCULAR DYSHEMIAS IN REHABILITATION OF PATIENTS WITH DEMENTIA AND APALLIC SYNDROME Lushchyk U.B., Babii I.P., Lushchyk N.G. Veritas Scientific Center Kyiv, Ukraine www.angio-veritas.com Cognitive functions’ disorders in the elderly are quite known and designated by different diagnoses in psychoneurological practice. However, the last decade has shown a tendency to younger patients with memory and cognitive functions’ disorders. Patients with apallic syndrome in a state of small consciousness also have similar symptoms of deep disorder of operative memory, disorientation in time and space. For 2000 - 2013 Veritas Scientific Centre has conducted examinations of 63 patients with apallic syndrome, 18 patients with dementia and a control group of 40 practically healthy people aged 45-85 years. All patients have got integrated clinical-instrumental and profound vascular diagnostics on micro- and macrolevels, neurodynamic diagnostics with individual correction on systemic and regional levels. Owing to the treatment and rehabilitation patented by Ukrainian patent Office (Patent № 72725 А as of 31.12.03) it was succeeded to restore higher cortical functions of the operative, long-term and professional memory, together with motor, sensitive, coordination and other disorders. The investigation has shown that all dementia patients had abnormal age level of blood supply – on the average deficit of blood supply was within the limits of 40-60%, in 58% - bilaterally in the area of MCA vascularization, in 72% - of ACA vascularization, in 32% - CCA and PCA vascularization. Specific hemodynamic patterns have been observed like arterio-venous disbalance towards venous hypotension by a hypervolemic type, expressed systolic dystonia and expressed venular overload on a background of the expressed hydrodynamic intracranial conflicts in 80% of patients. The intensive course of individually selected vasoactive therapy and psycho-neurorehabilitation course lasted from 2-3 months to 7 months with daily exercises. The correction of treatment scheme was weekly. The treatment algorithm of dementia patients can be considered regarding mixed vascular-neuronal deficiency by a type of gradual fading of blood pressure and expressed decline of nervous conductivity, disbalance in intersystem synergy.