Vol 6, No 2 (2024)

BACKGROUND: To increase the efficiency of motor recovery after a stroke in routine clinical practice, the search for selective biomarkers that determine the choice of the optimal strategy for noninvasive neuromodulation of the brain remains relevant. The study of interhemispheric interaction patterns can hypothetically help in determining the correct conceptual model of neuromodulation. AIM: To determine variants of interhemispheric interaction based on a correlation analysis of motor cortex excitability in patients with poststroke hemiparesis stratified by the degree of motor deficit. MATERIALS AND METHODS: This retrospective observational study involved 185 people (men, 56.2%; women, 43.8%) aged 19–88 years with verified poststroke hemiparesis and 40 healthy volunteers (men, 55.0%; women, 45.0%) aged 20–85 years. The patients underwent diagnostic transcranial magnetic stimulation in the projection of the cortical representation of m. abductor pollicis brevis and m. tibialis anterior of both brain hemispheres. The excitability level of the motor cortex and its interhemispheric asymmetry were recorded, and correlation analysis in subgroups stratified by the degree of paresis was performed. RESULTS: No interhemispheric correlation of resting motor thresholds (rMT) was found in patients with a level of muscle strength for the “hand” segment of 0–2 points (р >0.05). In the remaining subgroups, positive interhemispheric correlations of the rMT were noted (p <0.02). A positive correlation of the rMT of the damaged brain hemisphere and interhemispheric asymmetry of the motor cortex excitability for all degrees of paresis was observed when evaluating the cortical representation of the upper limb muscles. A negative correlation between the rMT of the unaffected brain hemisphere and interhemispheric asymmetry was detected for all degrees of motor deficit of the “foot” segment (p <0.02). CONCLUSION: The study did not confirm the concept of interhemispheric competition of the studied functional activity of the brain. Three authentic variants of interhemispheric interaction were identified: unidirectional hemispheric interaction with predominant reactivity of the affected hemisphere, unidirectional hemispheric interaction with predominant reactivity of the unaffected hemisphere, and functional interhemispheric dissociation. The results indicate the need to rethink some approaches to transcranial neuromodulation strategies in the analyzed cohort.

BACKGROUND: Currently, neurocognitive rehabilitation with the integration of innovative virtual reality (VR) technologies is the standard component of early rehabilitation treatment programs for patients with acute focal brain damage. AIM: Based on the statistical methodology, this study aimed to evaluate the efficiency of neurocognitive rehabilitation with the application VR technologies in patients with left and right hemisphere lesions in the acute period of ischemic stroke. MATERIALS AND METHODS: The study examined 160 patients diagnosed with ischemic stroke exhibiting cognitive impairments. Patients were divided into two groups based on stroke localization: group 1 (n=80) had left hemisphere lesions, whereas group 2 (n=80) had left hemisphere lesions. Since day 5 of hospitalization, in addition to basic therapy, rehabilitation was performed using a hardware–software multimedia complex based on VR for remote-controlled rehabilitation «Devirta-Delphi». Rehabilitation efficiency (RE) was assessed by testing objectively quantitative measures of accuracy and coordination of movement performance before and after treatment using a Kinect Delphi system. Cognitive and psychoemotional measures were assessed by neuropsychological tests on days 2–4 of hospitalization and at the end of the VR therapy. Mathematical statistics were calculated using Python programming language and its libraries Pandas and SciPy. RESULTS: Higher RE values were obtained in patients with right-sided stroke. Irrespective of lesion lateralization, significant improvement was noted with respect to mnestic, executive function, and ideomotor praxis, regression of anxiety, depression, and general aggression. Group 1 also showed an improvement in speech function and a decrease in general asthenia, whereas group 2 showed an increase in attention and emotion recognition ability. Factors that negatively affected RE were identified, namely, apathy, anxiety, prestroke cognitive decline, semantic aphasia, and decreased attention in group 1 and semantic and visual–spatial impairments, prestroke decline, and recurrent stroke in group 2. CONCLUSION: The application of an immersive environment in the early rehabilitation of patients with cognitive impairment improves the performance of verbal and visual tests reflecting mnestic, regulatory, and neurodynamic executive functions in lesions with different lateralization.

BACKGROUND: The global burden of stroke continues to rise and is the third leading cause of disability worldwide. The factors that influence the dynamics of recovery and functional outcomes in the acute period of stroke remain not fully understood. AIM: To examine the relationship between sex–age characteristics, comorbid status, and dynamics of the functional state in the acute period of stroke in patients living in the Arkhangelsk region. MATERIALS AND METHODS: A retrospective cohort study was conducted. The sex–age structure of patients, functional status according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) at hospital admission and discharge, and its dynamics during the hospitalization period were assessed. The relationship between FS and sex–age characteristics, stroke type, and concomitant diseases was analyzed. The dynamics of recovery were assessed using the rate of decline in NIHSS and mRs scores. RESULTS: The treatment results of 1,617 patients with stroke (male, n=968; female, n=649) mean age, 63.8±11.4 years) discharged from the neurological department in 2017–2020 were analyzed. Initially, more women experienced disability (p <0.001); however, their dynamics of recovery in the acute period of stroke were better than those of men. With increasing age, the rate of decline in the scores of the rating scales decreased. The best dynamics of recovery were observed in patients with atherothrombotic and lacunar types of stroke, and patients with cardioembolic stroke recovered the slowest. A high comorbidity burden was associated with poor functional outcomes. Independent associations were identified between the presence of atrial fibrillation, cerebral atherosclerosis, chronic heart failure, and a higher mRs score upon admission. At the time of discharge, atrial fibrillation, chronic heart failure, arterial hypertension, and coronary heart disease were independently associated with high mRs scores, and the presence of cerebral atherosclerosis was associated with lower mRs scores. CONCLUSION: Women recovered better, despite greater disability upon admission. Age and comorbidity burden served as reasons limiting the rate of recovery. Atrial fibrillation, chronic heart failure, coronary heart disease and arterial hypertension were the main comorbidities associated with worse functional outcomes at discharge. The results can be used to predict early functional outcomes in patients with stroke.

The study analyses the patterns of postural-cognitive interaction and their possible application in physical rehabilitation. The morphofunctional basis of the relationship between postural balance and cognitive functions is considered, particularly the role of the vestibular system in cognitive processes and the participation of cognitive functions in the regulation of equilibrium. The interaction patterns between postural balance and cognitive functions were analyzed, including the global nature of postural-cognitive interaction, influence of multitasking, and type of motor task (static or dynamic), its complexity, novelty and variability. The review presents the prospects and advantages of the practical application of the concept of postural-cognitive interaction in physical rehabilitation. These include the use of cognitive training methods in rehabilitation programs, which, due to the positive transfer of the effect of training, improves cognitive functions and postural stability and increases the ability to perform two or more tasks, including those related to activities of daily living. Vestibular training is another promising area of practical application of interaction between cognitive functions and postural balance; accordingly, vestibular–cognitive interaction contributes to the improvement of cognitive status. Considering the social significance of neurocognitive disorders and the importance of their early diagnosis, issues related to the identification of objective correlates and predictors of cognitive decline, particularly the basic spatial and spatiotemporal parameters of static posturography and stabilometric indices, are taken into account.

Upper limb dysfunction is a very common and severe problem in patients with central nervous system disorders. The restoration of arm and hand functions is one of the priority goals of medical rehabilitation in these patients. The development of new and effective rehabilitation technologies, implementation of a patient-centered approach, and objective assessment of rehabilitation outcomes require validated tools. This review aimed to introduce specialists to those tools that evaluate the rehabilitation outcomes based on the patient’s performance in standardized tasks (tests). Functional abilities of the upper extremities should be assessed based on the International Classification of Functioning, Disability and Health. The general concepts of these tests are discussed. Standard requirements for measurement tools (validity, reliability, and sensitivity) ensure the reliability of test results. The tests that focused on the hand and arm function are briefly described. Only tests that have good psychometric characteristics and are suitable for the monitoring of rehabilitation outcomes for patients with stroke, multiple sclerosis, and spinal cord injury are also presented in the review. In conclusion, the choice of a specific test is based on the purpose and objectives of the study (clinical practice or scientific research), motor deficit peculiarities, and rehabilitation unit resources. However, new and validated tools that focus on the assessment of hand function abilities in patients with central nervous system disorders are needed.