Disability after a stroke or brain injury is most often associated with impaired movement, speech, swallowing, and reduced cognitive abilities. By the end of the acute period of stroke, paresis in the arm and leg of varying degrees is observed in 80-90 % of survivors.In case of severe paresis, it is advisable to support the function of the limb at the early stages of recovery using modern specialized modifiable devices and methods that provide functional and multimodal stimulation and partial prosthetics. Aim of the study: evaluation of the efficacy of functional electrical stimulation (FES) in a complex of multimodal effects in restoring movement in Stroke patients with upper limb paresis (palcy).Methods. Stimulation and neuroprosthetic methods (FES - “Bioness H200”, RTMs) were used as the main therapeutic program of rehabilitation treatment for patients with motor disorders of the upper limb after an ischemic stroke (n=140). The median period of stroke was 25 [13; 56] days, median age 52 [48; 69] years. The standard methods of diagnosis and treatment of patients with stroke in accordance to the protocol of the Ministry of health of the Russian Federation No. 928 n and 1705 n (2012) were used, as well as scales and questionnaires for assessing the loss of strength and volume of motor disorders, assessing depression and motivation for treatment (Motricity Index), Fugl-Meyer AR, Medical Research Council Weakness Scale, Modified Ashworth Scale (MAS), Beck Depression Inventory; Beck At, Recovery Locus of Control, Patridge C., Johnstone M. Results. The effectiveness of personalized therapy with the use of a neuroprosthesis (“Bioness H200”) in patients in the acute period of ischemic stroke was shown, with the Motrisight index, Fugle-Meier scale being the most sensitive scales. the results depend on thebasic disease characteristics, the most relevant of which were - focus, degree of neurological deficit, personal motivation. The addition using of botulinum toxin allowed eliminating the inhibitory effect of spasticity, which prepared patients for intensive methods of physical rehabilitation. During the follow-up period, no complications were revealed. In 90% of cases, an increase in daily activity was noted. Functional electrical stimulation has significantly increased their level of self-care. The disability complex was initially equally pronounced in all patients, but positive reinforcement in the form of movement of the paretic hand against the background of FES led to a decrease in the severity of depression. In 100%, there was a high motivation to continue the treatment program with neuroprosthetics. Conclusion. The use of a complex of stimulating personalized techniques in the acute period of stroke is justified and safe. The useof FES significantly increases the range of motion in the hand, helps to overcome power paresis, coordination disorders, increases the general level of physical activity of patients after a stroke, motivation for the recovery process and improves the quality of life.
Disability after a stroke is most often associated with decreased patient activity due to walking disorder. In case of severe paresis, the function of the limb in the early stages of recovery is advisable to support with the help of partial prosthetics, using methods that provide functional stimulation. The complex treatment of central paresis includes botulinum therapy, which is due to the high incidence of spasticity. Aim: of the study: evaluation of the efficacy of functional electrical stimulation in a complex of multimodal effects in restoring movement in stroke patients with lower limb paresis. Materials and methods: Stimulation and neuroprosthetic methods (Bioness L300) were used as the main therapeutic program of rehabilitation treatment for patients with motor disorders of the lower limb after an ischemic stroke (n = 70). The median period of stroke was 21 [11; 47] days, median age 54 [42; 65] years. Scales and questionnaires were used to assess the loss of strength and volume of movement disorders, spasticity, walking speed and self-care (Medical Research Council Weakness Scale (1981, MRC), Barthel Index (1965), Modified Ashworth Scale (MAS), 10-meter test). Results: The effectiveness of personalized therapy with the use of a neuroprothesis (Bioness L300) in patients in the acute and early recovery period of ischemic stroke was shown. The additional use of botulinum toxin made it possible to eliminate the inhibitory effect of spasticity, which expanded the possibility of using intensive methods of physical rehabilitation. There was an increase in daily activity, walking speed, and the level of self-care of patients in 90 % of cases. Conclusion: The use of a complex of stimulating personalized techniques in the acute period of a stroke is justified and safe. The functional electrical stimulation helps to overcome power paresis, increases the overall level of physical activity of patients after a stroke, motivation for recovery and improves the quality of life. (1 figure, 2 tables, bibliography: 9 refs)
The aim of our study was to evaluate the role of early rehabilitation of patients with ischemic stroke after carotid endarterectomy. Material and methods. We examined a group of 28 patients with atherosclerotic carotid stenosis who had CEA in an acute period of stroke and who started rehabilitation in the early period of stroke. Patients of the 1st group were admitted to rehabilitation in the early stages (within 21 days after the stroke), patients of the 2nd group - in the delayed period (more than 60 days after the stroke).The results of treatment were assessed on the NIHSS scale, Rankin scale, Rivermead mobility scale, spasticity was assessed on the Ashworth scale. Results. An analysis of the long-term results of surgical treatment convincingly showed its positive effect on the neurological and neuropsychological status of patients with the most favorable outcomes in performing early rehabilitation.
Выписываясь из отделения анестезиологии, реанимации и интенсивной терапии, более 50 % пациентов испытывают патологические симптомы, не имеющие отношения к первичному неотложному состоянию, но снижающие качество жизни и требующие реабилитации. Совокупность таких симптомокомплексов называется «синдром последствий интенсивной терапии» (ПИТC). ПИТС включает: комплекс инфекционно-трофических, вегетативно-метаболических (хронизирующийся болевой синдром, нарушение циркадных ритмов, гравитационного градиента, нейромышечных (полимионейропатия критических состояний, респираторная нейропатия, дисфагия бездействия), эмоционально-когнитивных осложнений (депрессия, делирий, снижение памяти и пр.). Патофизиологической основой ПИТС является феномен «наученного неиспользования» (learned non-use), состояние искусственного ограничения двигательной и когнитивной активности пациента в результате применения анальгоседации, постельного режима и иммобилизации. Клиническая картина ПИТС определяется выраженностью отдельных его компонентов, детализируемых с применением пакета клиниметрических шкал. На основе результатов динамического тестирования рассчитывается индекс тяжести ПИТС. Сумма баллов в диапазоне от 0 до 10 отражает как факт наличия ПИТС, так и степень тяжести и потенциал реабилитационных мероприятий. Для профилактики ПИТС Союзом реабилитологов России совместно с Федерацией анестезиологов и реаниматологов России разработан реабилитационный комплекс РеабИТ. В англоязычной литературе такой комплекс называется “Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility” (ABCDEF bundle). РеабИТ — комплекс технологически лечебно-диагностических модулей «позиционирование и мобилизация», «профилактика дисфагии и нутритивного дефицита», «профилактика эмоционально-когнитивных нарушений и делирия», «профилактика утраты навыков самообслуживания». В соответствии с федеральным Порядком организации реабилитационной помощи для реализации РеабИТ предусмотрена организация отделения ранней реабилитации. Основу отделения составляет мультидисциплинарная реабилитационная команда, в которую входит врач по медицинской реабилитации, не менее 2 специалистов по физической реабилитации, специалист по эргореабилитации, медицинский психолог/врач-психотерапевт, медицинский логопед, медицинская сестра по медицинской реабилитации. Деятельность отделения ранней реабилитации оценивается на основании критериев качества и достижении основной цели РеабИТ — сохранение преморбидного статуса социализированности пациента. Пациенты с развившимся ПИТС маршрутизируются на этапы реабилитационного лечения с использованием шкалы реабилитационной маршрутизации на основе телемедицинских технологий.
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