Fesenko H. Determination of course and features of medical-social rehabilitation in patients with consequences of closed traumatic brain injury

The dissertation is devoted to the improvement of approaches to the diagnosis of the disabling consequences of a closed traumatic brain injury (TBI), considering the severity of the past trauma and the development of a methodology for individual prediction of the risk of long-term disability. The algorithm of using International Classification of Functioning disability and Health (ICF) core set for the TBI was developed, by means of the latter there were determined the main disorders of functioning and limitation of vitality in patients with the consequences of closed TBI of various severity degree. Based on the results of evaluating patients’ condition, by ICF core set for the TBI, there was proposed a system of determining rehabilitation potential in patients and disabled with the consequences of closed TBI. It was found that the most important risk factors for long-term disability are Walking, Control of voluntary movement functions, Conversation, the presence of intracranial hematoma in the acute period of TBI, fracture of the skull base or performed surgical intervention on the brain, lack of employment, presence of vestibular dysfunction and test results ≤24 points by the MoCA test. The use of the developed prognostic model of long-term disability makes it possible to identify the contingent of patients who need optimization of rehabilitation interventions. The peculiarities of cognitive impairments in patients with the consequences of a closed TBI, depending on the severity of the past trauma were studied. It has been determined that in patients with the consequences of TBI of moderate and severe degree for screening diagnosis of cognitive impairments, the use of the МоСА-test is effective and patients with the consequences of a mild TBI need additional attention and memory testing. It has been established that the indices of slow-wave, β-activity, α-activity and the asymmetry coefficient of α-activity in the remote period of TBI depend on the severity of the trauma. It was revealed that disturbances of autoregulation of cerebral circulation and venous dyscirculation are characteristic for the remote period of closed TBI and do not depend on the severity degree of the trauma, and the thickness of the intima-medial complex and the diameters of the right and left internal carotid arteries are significantly higher in patients with severe history of TBI.