«Vegetative Passport» and Rehabilitation Diagnosis in the Arthrologic Practice
The problem of establishing so-called rehabilitation diagnosis (RD) based on the International Classification of Functioning, Disability and Health is still little-known side of the doctor’s and psychologist’s practice. At the moment, there are no unified approaches to establishing RD by the different experts, completely missing general principles of RD for arthrologic group of patients, satisfying medical rehabilitation specialists or rheumatologists, however, the joint disease may be a certain model for solving the problem under discussion. This has become the purpose and the objective of this study.
Materials and methods. Proposed scientific concept was based on the analysis of survey results and on the effectiveness of subsequent rehabilitation of 643 patients suffering from joint diseases with various pathogenesis: 249 people with rheumatoid arthritis, 89 — with chronic gouty arthritis, 305 — with osteoarthritis.
Results. The necessity of RD, which is derived from clinical and functional diagnosis, is generally accepted throughout the world, but so far is little known among domestic rehabilitologists and is not used in the practice of rheumatologists, and RD is exactly a certain «key» of successful measures in rehabilitation treatment of patients suffering from joint diseases. The basis of RD classification was the principle of distribution of patients depending on the type of autonomic nervous system (vagotonics, sympathotonics and eutonics), on which the effectiveness of rehabilitation measures closely depends, with determination of the so-called «vegetative passport». If among healthy people of the same gender and age, the distribution of vagotonics, sympathotonics and eutonics was 1 : 3 : 5, then among the patients with rheumatoid arthritis, the persons with the dominance of sympathetic activity (sympathicotonics) significantly prevailed, and among other groups of patients with chronic joint disorders — of parasympathetic one (parasympathotonics). The major mediator for vagotonics is acetylcholine, and for sympathotonics — noradrenaline.
Conclusion. The proposed RD for rheumatoid, gouty arthritis and osteoarthritis based on «vegetative passport», degree of functional disorders of the musculoskeletal system, parameters of altered homeostasis and somatogenical forms will be adopted by rehabilitation specialists and rheumatologists in their practice, and on the proposed principles, further development and implementation of RD, mediated through types of autonomic nervous system, will take the rightful place in other specialists’ practice.
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