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Diaphragm dysfunction develops in central nervous system damage, chest injuries, complications of cardiac surgery, long-term artificial lung ventilation, respiratory diseases. Anatomical morphological features of phrenic nerves allow to effectively use electromagnetic stimulation methods for functional recovery of the diaphragm in different pathological conditions. Invasive and non-invasive, electric and magnetic methods of stimulation are used depending on the severity of manifestations of the diaphragm dysfunction and its genesis., Objective: To perform a review and comparison of modern methods of electromagnetic stimulation of the diaphragm; to determine the role of repetitive peripheral magnetic stimulation (rPMS) in the diaphragm dysfunction as a result of stroke., Material and Methods: An analysis of publications from the Pubmed and Elibrary databases for 2008-2024 years was conducted. The search was done by the following keywords: diaphragm dysfunction, repetitive peripheral magnetic stimulation of phrenic nerve, stroke, hemiparesis., Results: There is a real possibility of effective diaphragm stimulation for recovery of its function due to the innervation of the diaphragm strictly by the phrenic nerves, their large diameter, presence of myelinated fibers as well as anatomical location of the phrenic nerves. Direct electric stimulation of the phrenic nerve is usually applied in the case of long-term continuous support of respiratory function. Non-invasive techniques of electric or magnetic stimulation of the phrenic nerve or directly of the diaphragmatic muscle are used in the case of temporary respiratory support or recovery of diaphragm function. The motor neurons of the brain and peripheral nerves are activated, thus a peak strength of the variable magnetic field usually reachs 1-2 T in rPMS. Application of rPMS affects the efferent nerve fibers, causing muscle contractions, and activates sensory afferent fibers, creating a stimulating effect on the superjacent nervous structures. It is advisable to use rPMS of the phrenic nerve in the cervical segment or rPMS of one of the segments of the diaphragmatic muscle in the case of unilateral diaphragm lesion during the recovery period after stroke. It is important to consider the frequency of exposure in the 10-30 Hz range, the closest location of the coil to the stimulation area, the choice of the coil shape depending on the localization when adjusting parameters of rPMS., Conclusion: The use of rPMS of the phrenic nerve and diaphragm allows to preserve and recover motor and contractile functions of the diaphragm in different pathological conditions, including its unilateral lesion as a result of stroke. The method of rPMS of the phrenic nerves has a number of advantages over electric stimulation and repetitive transcranial magnetic stimulation, since it allows to achieve an effective motor response with less intensity of exposure, is painless and non-contact, better tolerated by patients.

Surgery is one of the leading treatment methods of patients with primary or recurrent malignant neoplasms in the thoracic or abdominal cavity. Extensive abdominal interventions are accompanied by such adverse outcomes as blood loss, hypoxia, inflammation, blood clotting abnormality, emotional and cognitive disorders, that increases the incidence of serious complications and worsens the treatment outcome and life quality in weakened oncological patients. Multimodal pre-rehabilitation before surgery can significantly decrease the incidence and severity of postoperative complications. The rehabilitation complex includes exercise therapy, nutritional and psychological support, smoking cessation and pharmacotherapy. Currently, there are a number of questions facing rehabilitation specialists and oncologists, that are related to the determination of pre-rehabilitation optimal timing and process duration, the choice of specific physical exercises, determining the load intensity. This review presents a current view on understanding of surgical stress in extensive abdominal interventions, its effect on the oncological process course, summarizes the experience of last years in choosing pre-rehabilitation program taking into account pathogenetic mechanisms of surgical stress and individual patient's characteristics. Special attention is paid to the comparison of physical exercises' various types, their action mechanisms at different stages of pathological process, the issues of load dosing during pre-rehabilitation activities.