Modern rehabilitation strategies of post-stroke motor disfunctions: functional electrical stimulation and biofeedback-stabilometric postural training

Dysfunction of the lower extremities in stroke. Development and scientific substantiation of individual complex strategies for the rehabilitation of stroke patients to improve motor functions and balance, taking into account the neuropsychological status.

Рубрика Медицина
Вид статья
Язык английский
Дата добавления 04.02.2021
Размер файла 12,7 K

Отправить свою хорошую работу в базу знаний просто. Используйте форму, расположенную ниже

Студенты, аспиранты, молодые ученые, использующие базу знаний в своей учебе и работе, будут вам очень благодарны.

Размещено на http://www.allbest.ru/

Modern rehabilitation strategies of post-stroke motor disfunctions: functional electrical stimulation and biofeedback-stabilometric postural training.

IE. Kostenko, 2L. Petrova, 2A. Rylsky, 2 M. Eneeva, 2 A. Ivanov

1Pirogov Russian National Research Medical University 2Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare Department

More than 80% of patients after a stroke have limited daily activity due to a complex polymorphic motor deficiency of various nature and severity, which leads to postural disorders (PD) [1]. Because of paresis develop different changes in the musculoskeletal system (MSS) such as PD, restrictions of movements in the joints, impaired relationships of links and levers of the motor-biomechanical system of the human body, balance disorders [2], that increase the risk of falls, lead to a low level of activity and participation, reduce the quality of life of patients with stroke [3-8].

In case of dysfunction of the lower extremities, the locomotor process splits, which normally provides simultaneous performance of the main functions: movement and balance (postural control - PC). Human supportability is determined by two components: the state of the MSS and balance through the friendly activity of proprioceptive, visual, vestibular analyzers with the coordinating role of the cerebellum. The balance function is directly related to the ability to move and is a predictor of achieving the ability to walk [8-10], and is also among the factors potentially modified by physical activity [11].

The after stroke patient's gait acquires a peculiar pattern, is characterized by a decrease in speed, violation of kinetic and kinematic profiles, pathological asymmetry, mediolateral deviation towards the unaffected lower limb, a greater instability of the center of pressure (COP) and an increase in the energy consumption of the motor act [12-14]. The asymmetry of the step parameters depends on the formed differences in spatio-temporal and kinematic characteristics between the affected and healthy side; muscle strength and support stability of the paretic limb [15]. The Cochrane review data on monitoring of the objective activity demonstrated the passivity of the lifestyle of post-stroke patients compared to age- comparable healthy individuals [16]. These patients spend more than 80% of the time on a sedentary lifestyle [17], which leads to a further decrease in cardiorespiratory reserves and overall endurance.

Thus, it is important to include in the program of rehabilitation of patients with stroke different physical factors, which, acting directly on the central nervous system (CNS), and on the segmental and peripheral structures of the neuromuscular apparatus, contribute to the restoration of motor functions.

Despite significant advances in the treatment of acute stroke, to date, evidence-based studies in the field of rehabilitation have not yet been conducted. Leading experts still recommend the available rehabilitation measures (physiotherapy, ergotherapy, kinesiotherapy, acupuncture, etc.), though the low class of recommendations [18]. There is no single methodology for the use of physiotherapeutic methods with proven effectiveness (functional electromyostimulation (FES), electrostimulation(ES), kinesiotherapy, etc.). Their effectiveness is not clear depending on the period of the stroke, the characteristics of the defeat of the dominant and subdominant hemispheres. There are open questions about the duration and frequency of procedures, the duration of therapy, periodicity and the combination of techniques.

In 2019, a group of scientists from different countries conducted a systematic review and metaanalysis of the effectiveness of various types of physical therapy (PT) on balance function and PC in patients with stroke [19].

In the described meta-analysis, both balance and PC were studied. Based on the International Classification of Functioning, Disability and Health (ICF), balance considered as a level of activity reflecting functional abilities, and postural control as a body structure function reflecting both orientation and stabilization body. Therefore, the primary outcomes were: balance measured by the Berg Balance Scale (BBS) or the Postural Assessment Scale for Stroke (PASS); postural deviation measured by the weight bearing asymmetry (WBA) on lower limbs or the mediolateral and anteroposterior position of the center of pressure (COP); and postural stability measured by all COP sway or limit of stability (LOS) parameters. The secondary result was an indicator of independence according to the scales:Barthel, functional independence, daily activity scale.

Of the 13,123 identified studies, 145 studies were selected with a total of 5912 patients; 18 had a crossover design and 127 parallel groups. The number of patients included in the study is from 7 to 408 people aged 46.9-78.5. A total of 91 studies with PT versus 76 studies without PT (NT) were analyzed; and 81 studies with PT compared with 70 studies that conducted standard therapy (ST). Meta-analyzes were performed with subgroups: PT categories, time after a stroke and localization of the lesion; and meta-regression (duration of PT).

The efficacy of PT immediately after the course of treatment has been proved compared to NT in relation to balance, mediolateral postural disturbances in EO and postural stability (PS); and compared with ST groups - the benefits for balance and PS (with EO and EC) after a stroke. Functional task-training, musculoskeletal interventions (MSI) and/or cardiopulmonary intervention, MSI using ES were more effective than NT in improving balance immediately after the procedure (). It is confirmed that only functional task-training had a beneficial effect on improving the balance compared to NT.

Significant positive results were obtained for constraint-induced therapy; of functional task-training, of musculoskeletal intervention with body awareness therapy and of musculoskeletal intervention by active strengthening. There were no significant improvements for acupuncture, sensory and other interventions (p=0.29). There was a significant positive results for the subgroup of chronic stroke patients and a nonsignificant results for the subgroup of acute-subacute stroke patients, without significant difference between subgroups (p = 0.64). In a subgroup of studies that included only patients with supratentorial stroke, a significant positive result was found.

It is interesting, that there was no statistically significant long-term effect of PT on the balance compared to ST in patients with stroke. Assistive devices were found to be more effective than NT relation to PS in EC; and functional training tasks and sensory interventions were more effective than NT and ST in improving orthostatic stability.

Thus, it is shown that the functional task-training associated with MMS and / or cardiopulmonary training and sensory interventions, affects the improvement of balance and PS. However, these results should be interpreted with caution due to the small number of studies, participants, or heterogeneity within subgroups.

Disturbances of sensory input and afferentation from a paretic limb both to the side of insufficiency and to the side of redundancy (spasticity) alter the activity of the motor centers and deform the static and dynamic motor program in patients with stroke. Obtaining information about the position of the COP, the inclusion of visual and auditory analyzers in training using biological feedback methods (BFB), along with the active effect on muscle conditions and impaired motor act, contribute to the accelerated formation of new functional connections at the CNS level, the development of a new functionally adapted stereotype movements, movement control and balance.

The comprehensive use of the FES and BFB- stabilometric training methods [20], which have a high safety profile, including in old age and high comorbidity, makes it possible to implement such a program.

A recently published randomized comparative study [20] involved 67 patients (mean age 58.4 ± 6.4 years) in the late recovery period of stroke who received a course of comprehensive rehabilitation for 5 weeks. By the end of the observation in the main group of patients (FES+BFB) statistically significantly increased walking speed (from 73,6±5,7 sec in the usual pace to 56.2±6,7 sec); COP leveled in both groups (significantly along the X-axis; p <0.05), decreased length of statokinesigram by an average of 27.4% at EO and 30% to the EC (596,77±89,6); the deviation of total COP in the sagittal plane decreased, that can be considered as an objective increase in patient resistance.

The Romberg coefficient improved (from 55.8 ± 6.81 to 95.2 ± 6.47; p <0.05), which indicated the restoration of deep proprioceptive sensitivity and an increase in its share of information in standing control. In patients with paresis of the limbs, the index of the position of total COP in the frontal plane (p <0.05) improved when performing functional tests (regression of paresis and posture asymmetry). There was a tendency towards a decrease in the rate of movement of the central nervous system (an indicator of overall stability). As a result, the patient has an earlier motor and social adaptation (changes on the Barthel scale from 58.2 ± 2.8 to 75.5 ± 3.7 points; p <0.001),restoration of impaired balance function, and improvement of quality of life (46.3 ± 2.3 versus 61.2 ± 3.0 at the end of the study; p <0.05).

It is necessary to emphasize the importance of a positive emotional reaction to physical activity during biofeedback training on the platform (impact on the mental component of motor deficiency; increased sensory input). The restructuring of the stabilogram coincided with clinical regression of statolocomotor disturbances. Thus, the inclusion in the rehabilitation process of a combination of methods of FES and biofeedback stabilometrictraining, makes a beneficial contribution to motor training and neuroplastic changes in the CNS. It provides long-term improvement of motor control, balance of muscle activation, quality, efficiency and ergonomics of walking [20].

Our center continues the development and scientific substantiation of individual comprehensive rehabilitation strategies to improve motor functions and balance, taking into account the neuropsychological and chronobiological status of post-stroke patients. This will allow to fully realize the patient's functional reserve and achieve maximum effectiveness of the activities.

References

stroke rehabilitation motor

1. Alexander LD, Black SE, Patterson KK, GaoF, Danells CJ, McIlroy WE. Association between gait asymmetry and brain lesion location in stroke patients.Stroke 2009;40:537-44.doi: 10.1161/STROKEAHA. 108.527374;

2. Geneva World Health Organization, editor. Global Health Estimates 2015: Burden of disease by Cause, Age, Sex, by Country and by Region, 20002015. 2016.

3. Geurts ACH, de Haart M, van Nes IJW, Duysens J. A review of standing balance recovery from stroke. Gait Posture 2005;22:267-81.https://doi.org/10.1016/j.gaitpost.2004.10.002 PMID: 16214666

4. Genthon N, Rougier P, Gissot A-S, Froger J,Pe'lissier J, Pe 'rennou D. Contribution of Each Lower Limb to Upright Standing in Stroke Patients.Stroke 2008;39:1793-9.https://doi.org/10.1161/STROKEAHA. 107.497701 PMID: 18369174Ishii F, Matsukawa N, Horiba M, Yamanaka

T, Hattori M, Wada I, et al. Impaired ability to shift weight onto the non-paretic leg in right-cortical braindamaged patients. ClinNeurolNeurosurg 2010; 112:406-12.https://doi.org/10.1016/j.clineuro.2010.02.006 PMID: 20227176

5. Dickstein R, Abulaffio N. Postural sway of the affected and nonaffected pelvis and leg in stance of hemiparetic patients. ArchPhysMedRehabil 2000; 81:364-7. PMID: 10724084

6. Bonan IV, Colle FM, Guichard JP, Vicaut E, Eisenfisz M, Tran Ba HuyP, et al. Reliance on visual information after stroke. Part I: balance on dynamic posturography 1 Arch Phys Med Rehabil 2004; 85:268-73.https://doi.Org/10.1016/j.apmr.2003.06.017 PMID: 14966712

7. Fulk GD, Reynolds C, Mondal S, Deutsch JE. Predicting home and community walking activity in people with stroke. ArchPhys MedRehabil 2010; 91:1582-1586.https://doi.org/10.1016/j.apmr.2010.07.005 PMID: 20875518

8. Lee KB, Lim SH, Ko EH, Kim YS, Lee KS,Hwang BY. Factors related to community ambulation in patients with chronic stroke. TopStrokeRehabil 2015;22:63-71.https://doi.org/10.1179/1074935714Z.0000000001 PMID: 25776122 21.

9. Louie D, Eng J. Berg Balance Scale score at admission can predict walking suitable for community ambulation at discharge from inpatient stroke rehabilitation. J RehabilMed 2018; 50:37-44. https://doi. org/10.2340/16501977-2280 PMID: 29068037

10. ThilarajahS, Mentiplay BF, Bower KJ, Tan D, Pua YH, Williams G, et al. Factors Associated With PostStroke Physical Activity: A Systematic Review and Meta-Analysis. ArchPhysMedRehabil 2018; 99:1876-89.https://doi.org/10.1016/j.apmr.2017.09.117 PMID: 29056502

11. C Maria Kim, Eng JJ. Magnitudeandpatternof 3D kinematic and kinetic gait profiles in persons with stroke: Relationship to walking speed. GaitPosture 2004;20(2):140-146. DOI:10.1016/j.gaitpost.2003.07.002;

12. Stanhope VA, Knarr BA, Reisman DS, Higginson JS. Frontal plane compensatory strategies associated with self-selected walking speed in individuals post-stroke. HHS AuthorManuscripts 2014;29(5):518-522.doi:10.1016/j.clinbiomech.2014.03.013;

13. Dawes H, Enzinger C, Johansen-Berg H, Bogdanovic M, Guy C, Collett J, Izadi H, Stagg C, Wade D, Matthews PM. Walking performance and its recovery in chronic stroke in relation to extent of lesion overlap with the descending motor tract. ExperimentalBrainResearch. 2008; 186 (2): 325-333. DOI: 10.1007/s00221-007-1237-0]

14. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. GaitPosture 2010;31:241-6. doi: 10.1016/j.gaitpost.2009.10.014].

15. Lynch EA, Jones TM, Simpson DB, Fini NA, KuysS, Borschmann K, Kramer S, Johnson L, Callisaya ML, Mahendran N, Janssen H, English C2. Activity monitors for increasing physical activity in adult stroke survivors. CochraneSystematicReview. Stroke 2018; 21: STROKEAHA118023088. doi: 10.1161/STROKEAHA. 118.023088.]

16. Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One 2014;4;9(2):e87987.doi:10.1371/journal.pone.0087987.

17. Neweditionofrecommendationsfortreatment and prevention of stroke and transient ischemicattacks(TIA),2018 http://doctorspb.m/artides.php?artide_id=557

18. Hugues A, Di Marco J, RibaultS, Ardaillon H, JaniaudP, XueY, et al. (2019) Limited evidence of physical therapy on balance after stroke: A systematic review and meta-analysis. PLoS ONE14(8):e0221700.https://doi.org/10.1371/journal.pone.0221700

19. Kostenko EV,Petrova LV,Rylsky AV,EneevaMA.Effectiveness of correction of post-stroke motor disorders using the methods of functional electrostimulation and BFB-stabilometric postural control.ZhNevrolPsikhiatrIm S SKorsakova. 2019;119(1):23-30.doi: 10.17116/jnevro2019n90n23

Размещено на Allbest.ru

...

Подобные документы

  • Causes of ischemic stroke. Assessment of individual risk for cardiovascular disease in humans. The development in patients of hypertension and coronary heart disease. Treatment in a modern hospital disorders biomarkers of coagulation and fibrinolysis.

    статья [14,8 K], добавлен 18.04.2015

  • The pathological process Acute Respiratory Distress Syndrome (ARDS). Specific challenges in mechanical ventilation of patients with ARDS. Causes of ARDS, and differential diagnosis. Treatment strategies and evidence behind them. Most common causes ARDS.

    презентация [2,6 M], добавлен 21.05.2015

  • Description of the directions of medical education in USA. The requirement for continuous training of doctors. Characteristics of the levels of their training to work with patients. Licensing of doctors through specialized advice and terms of the license.

    презентация [4,0 M], добавлен 10.11.2015

  • The development of modern medicine. The creation of internal organs, implants. The use of modern orthopaedics mechanical devices. The replacement of lost parts of the human body by means of surgical operations. Bridge denture. The use of prostheses.

    презентация [5,0 M], добавлен 31.05.2016

  • Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. The principal patients of neonatologists. Special education physician to become a neonatologist. Functions nurses.

    презентация [796,4 K], добавлен 26.05.2014

  • Features of the structure and anatomy of the heart, it's main functions and tasks in the body. Changes taking place in the human heart in the course of his life from birth to aging. Age-related disorders in the blood supply system and the heart.

    презентация [725,8 K], добавлен 16.10.2016

  • General characteristics, objectives and functions of medical ethics as a scientific discipline. The concept of harmlessness and its essence. Disagreement among physicians as to whether the non-maleficence principle excludes the practice of euthanasia.

    презентация [887,6 K], добавлен 21.02.2016

  • Body Water Compartments. The main general physico-chemical laws. Disorders of water and electrolyte balance. Methods bodies of water in the body, and clinical manifestations. Planning and implementation of treatment fluid and electrolyte disorders.

    презентация [1,1 M], добавлен 11.09.2014

  • The concept and the internal structure of the human respiratory system, the relationship of the individual components and functions, the value in the living organism. Principles of breathing gas composition.Scheme of the human respiratory system.

    презентация [1,4 M], добавлен 08.09.2015

  • The complement system - part of the immune system as a set of complex proteins. History of the concept. Its biological functions, regulation, role in diseases. Stages of activation: the alternative and lectin pathway. Mannose-binding Lectin deficiency.

    презентация [932,7 K], добавлен 17.03.2017

  • A brief sketch of the life and professional development of Botkin as the Russian scientist, a gifted doctor. Botkin's value in world medicine, assessment of its scientific achievements. Analysis and themes of famous doctor, the direction of its research.

    презентация [1,7 M], добавлен 10.12.2014

  • In anatomical and physiological aspect we can represent bronchopulmonary system as a combination of separate organs and functional subsystems, accordingly, in united functional system of organs of respiration of the person. Value and the function.

    реферат [16,3 K], добавлен 24.04.2008

  • Different classification schemes for dementias. His reasons. Risk Factors for Dementia. Dementia is diagnosed by using many methods such as patient's medical and family history, physical exam, neurological evaluations, cognitive and neuropsychological.

    презентация [775,8 K], добавлен 10.06.2013

  • Control the doctors’ prescriptions. Microchip in Blood Pressure Pills Nags Patients Who Skip Meds. Microchip implants linked to cancer in animal. Microchip Implants, Mind Control, and Cybernetics. Some about VeriChip. TI microchip technology in medicine.

    курсовая работа [732,8 K], добавлен 12.01.2012

  • The concept and the internal structure of the lungs, the main components and their interaction. Functional features of the lungs in the human body, their relationship with other anatomical systems. Existing pathology of respiratory organ and control.

    презентация [2,5 M], добавлен 12.02.2015

  • The brain as one of the largest and most complex organ in the human body. The physiological function of the brain, its divisions and share. The cerebral cortex of man. The principles of domination of the right and left hemispheres of different people.

    презентация [1,1 M], добавлен 20.11.2014

  • История заболевания, данные объективного исследования пациента: общие сведения, результаты скользящей пальпации, status localis. Дифферинциальная диагностика, клинический диагноз и его обоснование, лечение заболевания (общая и местная терапия), прогноз.

    история болезни [18,3 K], добавлен 03.03.2009

  • Orderliness (methodical) of the general inspection. The patient's position in bed. Constitution types - set of congenital and acquired the morphological and functional characteristics of the organism. Distinctive features of the constitutional types.

    презентация [2,1 M], добавлен 22.02.2015

  • Классификация штифтов, их назначение и показания к применению. Свойства штифтов DT-Post: характеристика поверхности, структурные особенности. Исследование in-vivo и клинические испытания волоконных штифтов. Рекомендуемые адгезивные системы для фиксации.

    курсовая работа [7,7 M], добавлен 12.05.2009

  • Classification of the resistance. External and internal barnry protecting the human body from pathological factors of the environment. The chemical composition of the blood, its role and significance. Influence the age on individual reactivity progeria.

    презентация [4,5 M], добавлен 17.10.2016

Работы в архивах красиво оформлены согласно требованиям ВУЗов и содержат рисунки, диаграммы, формулы и т.д.
PPT, PPTX и PDF-файлы представлены только в архивах.
Рекомендуем скачать работу.