This work aims to evaluate the prognostic value of the demographical and clinical data on long-term outcomes (up to 12 months) in patients with severe acquired brain injury with vegetative state/unresponsive wakefulness syndrome (VS/UWS/UWS) or a minimally conscious state (MCS). Patients (n = 211) with VS/UWS/UWS (n = 123) and MCS (n = 88) were admitted to the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology after anoxic brain injury (n = 53), vascular lesions (n = 59), traumatic brain injury (n = 93), and other causes (n = 6). At the beginning of the 12-month study, younger age and a higher score by the Coma Recovery Scale-Revised (CRS-R) predicted a survival. However, no reliable markers of significant positive dynamics of consciousness were found. Based on the etiology, anoxic brain injury has the most unfavorable prognosis. For patients with vascular lesions, the first three months after injury have the most important prognostic value. No correlations were found between survival, increased consciousness, and gender. The demographic and clinical characteristics of patients with chronic DOC can be used to predict long-term mortality in patients with chronic disorders of consciousness. Further research should be devoted to finding reliable predictors of recovery of consciousness.

According to the World Health Organization, injuries take first place among the causes of death among the population under 40 years of age. In the Russian Federation, in 2019, death from external causes, including injuries, was in third place in all deaths. Among the causes of disability first place. Mortality from severe traumatic brain injury is over 70%. The most common cause of disability and mortality is head injuries. Annually, 1.5 million people die from traumatic brain injury (TBI) in the world, and 2.4 million are disabled. According to the Federal State Budgetary Scientific Institution National Institute of Public Health named after N.A. Semashko, the annual damage from the head injury is estimated at 500 billion rubles. This is a serious socio-economic and state problem requiring complex and multidisciplinary intervention.

   Aim: to evaluate clinical effectiveness of selective hypothermia of cerebral cortex for the recovery of awareness in patients with chronic disorders of consciousness (CDC).   Material and methods. 111 patients with CDC 30 and more days after a cerebral event (ischemic or hemorrhagic stroke, brain injury) were included in the study. Exclusion criteria were anoxic brain injury (sequelae of a prolonged asystole or asphyxia), active sepsis, arrhythmia, baseline hypothermia (body temperature lower than 35.5 °С). Experimental group included 60 patients, of them 39 patients were in a vegetative state (VS), 21 patients exhibited patterns of minimally conscious state (MCS). Control group incluted 51 patients, of them 32 patients were in VS and 19 patients were in MCS. Patients in the experimental group received 10 sessions (120 minutes each) of selective brain hypothermia (SBH) during the 14-days follow-up period. Patients of both groups received standard identical neurological treatment and rehabilitation procedures. Patients in the control group did not undergo brain hypothermia. The induction of SBH involved cooling of the whole surface of the craniocerebral area of scalp using special helmets. The temperature of the internal surface of the helmet was 3–7 °С. Temperature of the frontal lobes of the cortex was monitored with non-invasive microwave radiothermometry, axillary temperature was also registered. The level of consciousness was evaluated using «Coma Recovery Scale-Revised» (CRS-R) scale.   Results. 120-minutes long SBH session reduced the temperature of the frontal lobes of the cerebral cortex by 2.4–3.1 °С with no impact on the axillary temperature. Evaluation using CRS-R revealed improvement in all studied functions (auditory, visual, motor, oromotor, communication, arousal) in patients in the experimental group after 10 SBH sessions. Level of consciousness in patients from the experimental group in VS increased from 4.5 ± 0.33 to 8.7 ± 0.91 points (P < 0.001), for patients in MCS from 11.3 ± 1.0 to 18.2 ± 0.70 (P < 0.001) points. In the control group, scores of patients in VS rose from 4.3 ± 0.37 to 6.8 ± 0.49 (P < 0.001) points with the most significant changes in auditory and visual functions (P<0.001). In the control group of patients in MCS the oromotor function improved (P < 0.05), overall CRS-R scores changed insignificantly from 9.1 ± 0.57 to 10.1 ± 0.86 (P < 0.1). The best outcome (CRS-R > 19 points) was seen in patients from the experimental group [6 in VS (15.4 %) and 8 in MCS (31.8 %)]. In the control group, the best results did not exceed 10 points for the patents in VS, while 4 patients in MCS (21 %) reached 12–16 scores. During 30-day follow-up period of hospitalization after the SBH sessions mortality rate was 10 % (6 patients) in the experimental group and 21.6% (11 patients) in the control group.   Conclusion. Patients with CDC could benefit from serial SBH sessions performed as a part of comprehensive treatment and rehabilitation strategy. We suggest that selective reduction of frontal lobe temperature improves neurogenesis, neuronal regeneration, and neuroplasticity.

The temperature of the brain can reflect the activity of its different regions, allowing us to evaluate the connections between them. A study involving 111 patients in a vegetative state or minimally conscious state used microwave radiometry to measure their cortical temperature. The patients were divided into a main group receiving a 10-day selective craniocerebral hypothermia (SCCH) procedure, and a control group receiving basic therapy and rehabilitation. The main group showed a significant improvement in consciousness level as measured by CRS-R assessment on day 14 compared to the control group. Temperature heterogeneity increased in patients who received SCCH, while remaining stable in the control group. The use of microwave radiometry to assess rehabilitation effectiveness and the inclusion of SCCH in rehabilitation programs appears to be a promising approach.

Medical rehabilitation is a complex, long-term and financially costly process of restoring the physiological functions of the body after injuries and the consequences of past diseases. The need for an individual approach to each life situation necessitates the search and development of new technologies in the method of providing rehabilitation assistance. One of the principles of a successful rehabilitation process is continuity, which, in most cases, is disrupted after the transfer of patients to the outpatient stage. The 21st century, in contrast to the previous one, is distinguished by more accessible technologies for everyday and individual use. A separate category of patients are patients with the consequences of brain damage, socialization and the return of the ability to self-serve for whom is one of the most difficult in rehabilitation practice. One of these technologies is distance rehabilitation, which provides the principle of continuity, social and informational support for relatives who provide care for patients on an outpatient basis.

Information and communication technologies penetrate into all areas of everyday life of modern society, learning, helping and replacing human labor. Without information technologies, it is already impossible to imagine the field of medical science: at present and in the near future, they will improve the continuity of health monitoring, take over the prediction of the risks of complications, the adjustment of drug therapy during life and many other processes. The article is devoted to the problems and prospects of information technologies in healthcare in Russia. The general model of information technologies, problems and ways of solving the restrictions from Western campaigns are highlighted. In view of the digitalization of the healthcare system in our country, the article talks about the need to ensure the continuity and independence from external influence of information technology systems in its full cycle: from client terminals, communication systems, to data storage and processing servers. The most important factor that allows us to speak with confidence about the development of specialized information technologies solutions in the healthcare system of the Russian Federation is an effective state policy in ensuring the digitalization of the economy: national projects, government programs, changes in legislation, roadmaps for achieving key indicators.