Электронный научный журнал

The article discusses the fundamental principles of restorative medicine in relation to patients who have undergone cardiac surgery. The aim of the study is to substantiate the inclusion of postural balance and coordination assessment in the structure of rehabilitation prognosis in elderly patients with cognitive impairment after cardiac surgery. Material and methods: the analysis of domestic and foreign literature (36 sources) on restorative medicine, postoperative cognitive impairment, postural control and rehabilitation prognosis was carried out. Results: it is shown that after cardiac surgery a complex of interrelated disorders is formed — cardiac, post-sternotomy, respiratory, hemorheological, hypodynamic, psychopathological and cognitive syndromes. Cognitive impairment occurs in 40–70% of patients over 65 years in the early postoperative period and in 30–50% in the long-term period, which makes the problem not only medical but also gerontological. Cognitive deficit sharply limits vital activity: the ability to move independently, control one's condition, motivation for recovery, communication and planning is lost, which leads to social maladjustment and disability. The relationship between postural balance and cognitive functions through common neurobiological mechanisms is substantiated: dysfunction of frontal-subcortical connections, decreased cognitive reserve, impaired neurotransmitter balance. The dual-task method demonstrates that when simultaneously maintaining posture and performing a cognitive task, both components suffer, which reflects a decrease in cognitive reserve and impaired attention distribution. The role of coordination abilities as a marker of rehabilitation reserve is emphasized: a patient with preserved coordination and physiological respiratory pattern has more reserves for recovery. Recommended diagnostic methods include neuropsychological tests (MoCA, MMSE, verbal fluency test, Stroop test), geriatric assessment (Timed Up and Go test, Tinetti scale, fall risk assessment), instrumental methods (stabilodiagnostics and stabilometry on the ST-150 stabiloplatform, dual-task test), laboratory markers (neuron-specific enolase, S-100 protein). Conclusions: rehabilitation prognosis after cardiac surgery in gerontology should be based on both cognitive status and balance state; it is advisable to include coordination assessment in the prognosis structure, which allows more accurate determination of the need for intensive and long-term rehabilitation.