Bulletin of Rehabilitation MedicineBulletin of Rehabilitation MedicineВестник восстановительной медицины2078-19622713-2625National Medical Research Center for Rehabilitation and Balneology62607410.38025/2078-1962-2023-22-5-22-29ArticlesСтатьиResearch ArticleEffectiveness and Safety of Robotic Mechanotherapy with FES and VR in Restoring Gait and Balance in the Acute and Early Rehabilitation Period of Ischemic Stroke: Prospective Randomized Comparative StudyОпыт применения технологий роботизированной механотерапии с функциональной электростимуляцией и виртуальной реальности в восстановлении ходьбы и равновесия в остром и раннем реабилитационном периоде ишемического инсультаhttps://orcid.org/0000-0003-1312-9797LutokhinGleb M.ЛутохинГ. М.
Russian Federation

Ph. D. (Med.), Senior Researcher, Medical Rehabilitation Department

gleb.lutohin@gmail.comhttps://orcid.org/0000-0001-7483-1796KashezhevAlim G.КашежевА. Г.
Russian Federation

Ph. D. (Med.), Senior Researcher, Medical Rehabilitation Department

gleb.lutohin@gmail.comhttps://orcid.org/0000-0001-5123-5991PogonchenkovaIrena V.ПогонченковаИ. В.
Russian Federation

Dr. Sci. (Med.), Associate Professor, Director, Chief external specialist in medical rehabilitation and sanatorium-resort treatment

gleb.lutohin@gmail.comhttps://orcid.org/0000-0002-9566-9799RassulovaMarina A.РассуловаМ. А.
Russian Federation

Dr. Sci. (Med.), Professor, First Vice Director

gleb.lutohin@gmail.comhttps://orcid.org/0000-0002-4397-3270TurovaElena A.ТуроваЕ. А.
Russian Federation

Dr. Sci. (Med.), Professor, Deputy Director

gleb.lutohin@gmail.comhttps://orcid.org/0000-0002-3277-6255UtegenovaYuliya V.УтегеноваЮ. В.
Russian Federation

Neurologist, Medical Rehabilitation Department No. 1, Branch No. 3 of the Multidisciplinary Medical Rehabilitation Clinic

gleb.lutohin@gmail.comhttps://orcid.org/0000-0003-2842-3016ShulkinaAnna V.ШулькинаА. В.
Russian Federation

Neurologist, Medical Rehabilitation Department No. 1, Branch No. 3 of the Multidisciplinary Medical Rehabilitation Clinic

gleb.lutohin@gmail.comhttps://orcid.org/0000-0001-9038-296XSamokhvalovRoman I.СамохваловР. И.
Russian Federation

Ph. D. (Med.), Deputy Head, Branch No. 3

gleb.lutohin@gmail.comMoscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare DepartmentГАУЗ «Московский научно-практический центр медицинской реабилитации, восстановительной и спортивной медицины» Департамента здравоохранения г. Москвы15112023225222926012024Copyright ©; 2023, Lutokhin G.M., Kashezhev A.G., Pogonchenkova I.V., Rassulova M.A., Turova E.A., Utegenova Y.V., Shulkina A.V., Samokhvalov R.I.Copyright ©; 2023, Лутохин Г.М., Кашежев А.Г., Погонченкова И.В., Рассулова М.А., Турова Е.А., Утегенова Ю.В., Шулькина А.В., Самохвалов Р.И.2023Lutokhin G.M., Kashezhev A.G., Pogonchenkova I.V., Rassulova M.A., Turova E.A., Utegenova Y.V., Shulkina A.V., Samokhvalov R.I.Лутохин Г.М., Кашежев А.Г., Погонченкова И.В., Рассулова М.А., Турова Е.А., Утегенова Ю.В., Шулькина А.В., Самохвалов Р.И.https://creativecommons.org/licenses/by/4.0https://journals.eco-vector.com/2078-1962/article/view/626074

INTRODUCTION. Impaired gait and balance after a stroke significantly affect patients' daily activities and quality of life. Robotic mechanotherapy and virtual reality technologies are actively studied and used to restore lower limb muscle strength, balance and gait pattern.

AIM. To assess the effectiveness and safety of rehabilitation using robotic mechanotherapy (exoskeleton) with functional electrical stimulation (FES) and virtual reality (VR) technology with plantar stimulation in the restoration of gait and balance disorders in patients in acute and early recovery periods of ischemic stroke.

MATERIAL AND METHODS. Men and women aged 39 to 75 with ischemic stroke in acute and early recovery periods with gait impairment and lower limb paresis from 0 to 4 MRC scores. The patients were randomized using the envelope method into 4 groups: Group 1 (33 people) — exoskeleton with FES, Group 2 (32 people) — combined application of robotic mechanotherapy with FES and VR with plantar stimulation, Group 3 (35 people) — VR with plantar stimulation, Control group (30 people) — conventional training.

RESULTS. Group 2 and 3 had significantly greater increases in muscle strength in the hip extensors, tibia flexors and flexors of the foot compared to the control group. Patients in the main groups also had a significant improvement in Tinetti Walking and balance Scale at follow-up. The analysis of the stabilometry results on the first and last day of the study revealed a decrease in the area of the statokinesiogram in the main groups both in the intragroup comparison and in the comparison with the control group.

DISCUSSION AND CONCLUSION. Exoskeleton gait training with FES and exercises on a VR with plantar stimulation, as well as combined use of these techniques allowed to achieve better recovery of lower limb muscle strength, walking functions and balance in patients in acute and early rehabilitation periods of stroke. This is probably due to the large number of steps or their imitation performed by the patient during rehabilitation sessions, which leads to activation of neuroplasticity and better recovery. The study demonstrated the safety and efficacy of an exoskeleton interval training system that prevents the development of orthostatic hypotension in patients in the acute period of ischemic stroke.

ВВЕДЕНИЕ. Нарушение ходьбы и равновесия после перенесенного инсульта в значительной степени влияют на повседневную активность и качество жизни больных. Роботизированная механотерапия и технологии виртуальной реальности активно изучаются и используются для восстановления силы мышц нижних конечностей, баланса и паттерна ходьбы.

ЦЕЛЬ. Исследование эффективности и безопасности реабилитационных программ с применением технологии роботизированной механотерапии (экзоскелет) с функциональной электростимуляцией (ФЭС) и технологии виртуальной реальности (ВР) с подошвенной стимуляцией в восстановлении нарушений ходьбы и у пациентов в остром и раннем восстановительном периодах ишемического инсульта.

МАТЕРИАЛЫ И МЕТОДЫ. В исследование были включены мужчины и женщины в возрасте от 35 до 75 лет с впервые возникшим ишемическим инсультом в остром и раннем восстановительном периоде. Выраженность пареза нижних конечностей составляла от 0 до 4 баллов по MRC. Пациенты были распределены случайным порядком в 4 группы: группа 1 (33 пациента) — применение экзоскелета с ФЭС, группа 2 (32 пациента) — комбинированное применение экзоскелета с ФЭС и ВР с подошвенной стимуляцией, группа 3 (35 пациентов) — применение ВР с подошвенной стимуляцией, контрольная группа (30 больных).

ОБСУЖДЕНИЕ И ЗАКЛЮЧЕНИЕ. Восстановление ходьбы в экзоскелете с ФЭС и занятия на тренажере ВР с подошвенной стимуляцией, а также комбинированное применение этих методик позволили добиться лучшего восстановления силы мышц нижних конечностей, функций ходьбы и равновесия у пациентов в остром и раннем восстановительном периодах ишемического инсульта.

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