A BCI-controlled hand exoskeleton activates neuroplasticity mechanisms, promoting motor learning. The contribution of perception to this phenomenon is understudied. The aim of this study was to assess the impact of sensorimotor integration on the effectiveness of neurorehabilitation based on the learning of a hand opening movement by stroke patients using BCI and to investigate the effect of ideomotor training on spasticity in the paretic hand. The study was conducted in 58 patients (median age: 63 (22; 83) years) with traumatic brain injury, ischemic (76%) or hemorrhagic (24%) stroke in the preceding 2 (1.0; 12.0) months. The patients received 15 (12; 21) ideomotor training sessions with a BMI-controlled hand exoskeleton. Hand function was assessed before and after rehabilitation on the Fugl–Meyer, ARAT, Frenchay, FIM, Rivermead, and Ashworth scales. An increase in muscle strength was observed in 40% of patients during flexion and extension of the radiocarpal joint and in 29% of patients during the abduction and adduction of the joint. Muscle strength simultaneously increased during the abduction and adduction of the radiocarpal joint (p < 0.004). Ideomotor training is ineffective for reducing spasticity because no statistically significant reduction in muscle tone was detected. Improved motor performance of the paretic hand was positively correlated with improvements in daily activities. Motor training of the paretic hand with a robotic orthosis activates kinesthetic receptors, restores sensation and improves fine motor skills through better sensorimotor integration.
With the development of high technologies in medicine, the diagnostic process is improving, the methods of treating patients are refining, the percentage of patients who survived after serious injuries, diseases and/or conditions is increasing. The issue of the patients` quality of life that received primary medical, specialized, including high-tech medical care is becoming a priority for health care. Rehabilitation is defined as one of the critical interventions “enabling people with disabilities to achieve and maintain maximum independence, full physical, mental, social and professional ability and full inclusion and participation in all aspects of life”. The problems and prospects of rehabilitation medicine for the future arise due to critical changes in demographics, life expectancy, a variation in approaches to assessing disability, an increase in the prevalence of long-term health disorders, especially in connection with the new coronavirus infection, technological progress, as well as changes in health care costs and changes in society’s requirements for well-being and quality of life, including health.
The object of the study is the process of organizing medical rehabilitation of patients with cerebral stroke at the second phase of rehabilitation process in a 24-hour inpatient medical rehabilitation department for patients with impaired function, structures, limited activity and participation due to damage to the central nervous system based on the application of the International Classification of Functioning, Disabilities and Health (ICF) for the rehabilitation diagnosis description (the degree of disturbance of structure, function, limitation of activity and participation, the degree of influence of environmental factors) and the formation of the medical rehabilitation program on its basis.
Цель исследования — улучшение непосредственных, отдаленных и функциональных результатов хирургического лечения больных раком прямой кишки пожилого и старческого возраста.Материал и методы исследования. В исследование включены 312 больных раком прямой кишки старческого возраста обоих полов (75 лет и старше), которые подверглись радикальному лечению в Республиканском онкологическом центре им. профессора Г. В. Бондаря с 1990 по 2015 г. г. Основным способом оперативного вмешательства явилась брюшно-анальная резекция — 229(73,4%), что связано с частой локализацией опухоли в дистальных отделах прямой кишки — ниже 9см от перианальной кожи, а также осложненным течением и выраженной сопутствующей патологией в большинстве случаев. Лишь в 9 (2,9%) наблюдений оперативное вмешательство закончилось формированием колостомы — выполнены операции Гартмана, что обуславливалось наличием выраженного осложненного течения.Результаты. Интраоперационные осложнения отмечены в 16(5,1%), послеоперационные — у 45(14,4%) больных, послеоперационная летальность составила 15 (4,8%), что можно считать удовлетворительным результатом, учитывая тяжесть контингента больных. Для всех стадий радикально оперированных больных 5-летняя выживаемость составила более половины случаев, а средняя продолжительность жизни стремится к 4 годам, что соответствует данным литературы по лечению рака прямой кишки для всех возрастных групп.Заключение. Представленный материал из 312 наблюдений хирургического лечения рака прямой кишки у пациентов пожилого и старческого возраста (старше 75 лет) продемонстрировал обнадеживающие непосредственные и отдаленные результаты использования первично-восстановительных и сфинктерсохраняющих резекций, как основной хирургической тактики лечения данного контингента больных.
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