OPTIMIZATION OF MEDICAL AID PROVIDED TO DISABLED CHILDREN WITH DISTRUBANCES OF THE PELVIC ORGANS IN A MULTI-FIELD HOSPITAL

A program of complex examination and treatment of children with functional disorders of the pelvic organs of organic genesis was initiated on the basis of a multipurpose level III medical treatment facility of Moscow Heath Department in summer 2014. 30-bed assisted uronephrological health care facility for simultaneous hospitalization of a disabled child and his/her mother (or custodian) was located at the division of nephrology. In total 36 children (with parents) with a disturbed function of the pelvic organs such as disturbed spontaneous evacuation of the urinary bladder and bowel in 26 children and incomplete evacuation of the urinary bladder and bowel in 10 children were hospitalized. Vegetovascular dystonia with fixed bradycardia on ECG was found in 19 children (68%). Hydrocephalus was observed in 16 cases (57%). Primary shunting operation was performed at the age of 28-56 days. On the part of social adaptation, there was a lack of communication with peers in 7 children, disturbed relationships between parents and children due to the presence of disorder in 5 patients, acute concerns for the future in 6 children, depression in 8 children, and social ills in 10 patients. The conducted examination included consultations by a neurologist, urologist, nephrologist, orthopedist, neurosurgeon, physical therapist, physiotherapist, and doctor engaged in laboratory and instrumental diagnostics. 12 people had the syndrome of spinal cord fixation, disturbed support of the lower extremities, and disturbed independent evacuation and defecation (group 1). 10 other patients had no syndrome of spinal cord fixation in disturbed evacuation of the urinary bladder and intestine without preliminary attempts to restore urination and defecation acts (group 2). 14 people who had undergone orthopedic interventions had partially restored urination and defecations acts (group 3). The conducted course of diagnostics and treatment accounted for 12-16 bed days. It included 8-12 procedures of physiotherapy, massage and therapeutic exercise. Consultation of a child and his/her parent by a psychologist was conducted for at least 10 days. The most successful methods of mental therapy for adults and children were represented by Jungian art therapy and clinical conversation. Patient appointment scheduling was formed considering the results of diagnostics and treatment. Group (1) with the syndrome of spinal cord fixation was sent for planned surgical treatment to the department of neurosurgery. Children with disturbed support were shifted to the group of planned surgical treatment at the orthopedic department whereas the 3rd group of children with incontinence of urine and fecal incontinence was sent for planned treatment to the department of neurourology. From a multidisciplinary perspective, disabled children with myelodysplasia require a complex examination and treatment of organs and systems to optimize medical aid.

миелодисплазия, реабилитация, социальная адаптация, психологическая и семейная терапия, дети, myelodysplasia, rehabilitation, social adaptation, psychological and family therapy, children