Objective. To analyze the literature on rehabilitation of patients in late period after spinal cord injury from the standpoint of evidencebased medicine. Material and Methods. The study design is a meta-analysis of publications with levels 1a, b, c, and 2a evidence and a level A recommendations. An electronic search was conducted in the PubMed, Web of Science, Scopus, Cochrane Library, CrossRef, AO Spine, Eurospine, ResearchGate, eLIBRARY, and MEDLINE databases, and in references of key articles. Inclusion criteria were systematic reviews, randomized controlled studies, multicenter cohort studies with a level 1a, b, c, and 2a evidence and level A recommendations for adult patients with Цель исследования. С позиций доказательной медицины провести анализ литературных источников по вопросам реабилитации пациентов в отдаленном периоде травмы спинного мозга. Материал и методы. Дизайн исследования-метаанализ публикаций с уровнем доказательности 1а, b, c, 2a и уровнем рекомендаций А. Проведен электронный поиск по базам данных PubMed, Web of Science, Scopus, Cochrane Library, CrossRef, AO Spine, Eurospine, ResearchGate, eLIBRARY, MEDLINE и по библиографии ключевых статей. Критерии включения: систематические обзоры, рандомизированные контролируемые исследования, мультицентровые когортные исследования с уровнем доказательности 1а, b, c, 2a и уровнем рекомендаций А для взрослых пациентов с отдаленными последствиями травмы спинного мозга (более 4 мес. после травмы). Критерии исключения: тематические статьи, клинические случаи, наблюдения, когортные неконтролируемые исследования, экспериментальные исследования, доклады, статьи с уровнями доказательности 2b, c, 3a, b, 4, 5 и уровнями рекомендаций B, C, D, детский возраст пациентов, ранний период после травмы спинного мозга (менее 4 мес.), нетравматические поражения спинного мозга. Результаты. Найдено 108 статей с датой публикации 1997-2019 гг. Критериям включения соответствовали 65 публикаций: 33 систематических обзора, 12 рандомизированных контролируемых исследований, 19 мультицентровых работ, одно открытое проспективное исследование включено в обзор в связи с особенностями используемого метода лечения. Наибольшая доказательная база при реабилитации пациентов в отдаленном периоде травмы спинного мозга представлена для физических методов реабилитации. Наиболее эффективными являются локомоторные тренировки по отработке навыков передвижения. Вспомогательные вертикализирующие и роботизированные устройства необходимы для восстановления и улучшения проприоцептивной иннервации. При нарушении проводящих путей спинного мозга восстановление двигательных функций происходит за счет активизации супраспинальных интернейронных связей. Эпидуральная электростимуляция поясничного утолщения спинного мозга активизирует генератор произвольных двигательных движений конечностей и в сочетании с тренировками проприоцептивной чувствительности приводит к регрессу двигательных нарушений. Постоянное применение электростимуляции блокирует проприоцептивную чувствительность и угнетает восстановление спиналь...

No abstract

INTRODUCTION: In the long-term course of traumatic spinal cord disease (TSCD), neuroplastic adaptive and maladaptive changes occurred on different structural levels of the nervous system, which leads to a shift in the activation and strength characteristics of the limb muscles. The standard neurological assessment is approximate; therefore, objective instrumental studies of the motor sphere of patients with partial damage to the cervical spinal cord have not lost their significance. AIM: To study the activation and strength characteristics of the limb muscles of patients with partial injury of the cervical spinal cord in the long-term course of the disease (type B on the American Spinal Cord Injury Association (ASIA) scale). MATERIALS AND METHODS: The study enrolled 28 patients with fractures of the cervical spinal cord vertebrae in the late period of the TSCD of ASIA type B. The amplitude of motor responses (M-responses) of the upper and lower limbs was assessed using electroneuromyography. The strength of the upper limb muscles was evaluated using manual dynamometers. RESULTS: M-responses were absent in 9% and 64% in the upper and lower limbs, respectively. The amplitude of the most recorded M-responses of the upper and lower limb muscles was reduced relative to the norm. The reduction was not uniform, with significant differences in different leads. The average values of the amplitude asymmetry of M-responses did not exceed the norm. Moreover, 61% of the patients could perform hand-grip functions and hold the wrist dynamometer. Only 59% of the patients could make an effort and the results of strength measurement were obtained, whereas in 41% of cases, zero values were obtained. Statistical analyses revealed a clear relationship between the motor deficiency index of the upper limb and hand-grip strength. CONCLUSION: The degree of preservation of M-responses and evident asymmetry of evoked electrical activities of the upper and lower limb muscles indicate the existence of a certain level of neurotrophic interaction in the muscle fibermotor neuron system. The level of reduction of the hand-grip strength and its relationship with the motor deficiency index allows discussion about the partial preservation of the voluntary control of the motor function of the upper limbs.

Background. The standard neurological assessment in patients with long-term consequences of spine-and-spinal cord injury and severe neurological deficit does not allow to accurately identify changes in sensitivity that determine the level, degree and nature of spinal cord injury, as well as to evaluate the minimal dynamics of these disorders with different treatment options. As a result, an objective instrumental assessment of the sensory sphere in the long-term period of spinal cord injury has not lost its relevance.The aim. To conduct an instrumental study of the temperature-pain sensitivity condition in patients with partial gross damage to the cervical spinal cord in the long-term period of the disease (type B on the ASIA scale).Methods. We examined 23 patients with consequences of vertebral fractures of the cervical spine in the late period of traumatic spinal cord disease, Grade B on the ASIA scale ASIA. The clinical analysis of sensitive disorders was performed according to ISNCSCI and ASIA scales. While studying the temperature-pain sensitivity the threshold of thermal sensitivity and the threshold of pain from hot were determined in СIV–SI dermatomes on the right and on the left using an electricesthesiometer.Results. The examined patients had hypesthesia of heat and pain sensitivity, hyperesthesia of pain sensitivity, thermoanesthesia and thermoanalgesia. The degree of changes in the temperature-pain sensitivity depended on the topographic localization of dermatomes. The more distally the study area was located from the level of damage, the more pronounced the disorders were. In 30.4 % of patients, the pain sensitivity from hot in the chain of dermatomes from CIV to SI was preserved on at least one side. The combination of thermoanesthesia with thermoanalgesia was observed in 69.6 % of cases in dermatomes with ThVII and distally.Conclusions. The instrumentally registered level of the temperature-pain sensitivity disorder did not correspond to clinically determined localization of sensory disorders. The range of discrepancy ranged from 2 to 12 dermatomes, with defining the sensitivity subclinical deficit over the area of clinical sensory disorders.