No abstract

Background. Impairment of fine motor skills in the hand is one of the most frequent causes of the persistent loss of professional skills, social maladjustment, and the impossibility of self-care in patients after a stroke, which ultimately leads to a significant reduction in the quality of their life. The article discusses the features of the fine motor skills’ impairment in the hand in patients after a stroke, in the context of a lateralized hemispheric lesion. Methods. We have studied 26 patients after a primary ischemic stroke in the pool of middle cerebral artery of the right (n=12) or left (n=14) brain hemisphere. The average age of patients was 55.7±7.3 years. Patients with a right-sided ischemic stroke were comparable to those with a left-sided stroke in their age, disease duration, size of the lesion and the gender ratio. Results. All the patients after an ischemic stroke had motor impairment in the form of a hemiparesis of a mild or moderate degree. Discussion. We suggest the existence of differentiated mechanisms for the development of fine and highly coordinated voluntary movements in the hand of patients after an ischemic stroke, depending on the lateralization of the supratentorial lesion: diffuse deficit of the afferent support in a right-sided ischemic stroke vs. bilateral efferent deficit for a left hemisphere lesion. Conclusion. The obtained data on the differentiated mechanisms for the development of fine and highly coordinated voluntary movements in the hand of patients after an ischemic stroke warrant the necessity of a further, more targeted research on those disorders in the post-stroke period, on order to optimize the existing rehabilitation approaches and improve the functional potential and quality of life of such patients.

The purpose. The article is devoted to chronic pain (CP) in elderly patients and the possibilities of various therapeutic strategies for this category of patients.Basic provisions. Chronic pain and the biological aging process have similar pathophysiological (cellular and molecular) mechanisms of development. However, chronic pain is not an inevitable component of the aging process, however, it is much more common in older people, the diagnosis and therapy of which is associated with atypical clinical manifestations of pain in elderly patients and the need for a more attentive, balanced approach when assessing pharmacokinetic and pharmacodynamic changes associated with the aging process. To ensure adequate pain relief, a multidisciplinary approach and appropriate therapies are used.Conclusion. The final result of CP treatment (reduction in pain intensity, restoration of functional activity, autonomy, etc.) depends on polymorbidity, geriatric status and cognitive capabilities of the patient; therefore, it is necessary to take into account all available factors for adequate and complete pain therapy.

We present a review of the literature and our own data on the management and rehabilitation of impairment or persis‑tent loss of the olfactory function – hypo‑ and anosmia. Approaches for restoring impaired olfactory function can be divided into olfactory training, pharmacological and physiotherapy. Smell training is carried out according to a number of protocols that differ mainly in the used arsenal of smells, as well as in the frequency of their presentation. Pharma‑cologically, it is proposed to use steroids used both topically (intranasally) and systemically; there is no common view on the effectiveness of this approach. Physiotherapy involve electrical stimulation of the olfactory filaments in the area of their exit into the nasal cavity (lateral masses of the ethmoid bone). In our opinion the most rational approach is the use of training methods using different smells.