Vol 6, No 3 (2024)

BACKGROUND: Gait disorders are common among 80% of stroke patients. Its consequences include increased risk of falls and functional limitations, which can significantly reduce the quality of life.

AIM: To investigate the functional profile of hemiparesis resulting from subacute ischemic stroke.

MATERIALS AND METHODS: This observational, retrospective, one-stage, single-center study analyzed primary biomechanical gait parameters in 31 patients and 34 healthy controls. Spatial, temporal, kinematic, and electromyographic characteristics were recorded. A statistical assessment and inter-group and intra-group comparison of the collected data were performed to identify the pathognomonic features of hemiplegic gait in patients with subacute stroke.

RESULTS: Changes in gait biomechanics typical for hemiparetic patients who have suffered from ischemic stroke were described: slight asymmetry of step cycle, normal duration of support period on the paretic side, significant increase in duration of support period on the healthy side, and shortening of single support period on the paretic side. Additionally, the asymmetry of the walking function was characterized by changes in reciprocity, that is, a harmonious sequence of step cycles. The function of the hip and knee joints was reduced and altered, and the amplitude of the ankle joint was increased. Decrease and change in the bioelectric activity profile of muscles were detected. Moreover, the quadriceps femoris function was least affected.

CONCLUSION: The main changes in walking function are characterized by an asymmetry of spatiotemporal parameters, a decrease in movement amplitudes of the hip and knee joints on the paretic side, an increase in ankle joint amplitude, a decrease in the bioelectric activity of muscles, and a shift in the phases of their activity. The results contribute to a better understanding of the mechanisms behind hemiplegic gait and provide a valuable tool for developing more personalized and targeted rehabilitation plans for patients suffering from hemiparesis as a result of subacute ischemic stroke.

BACKGROUND: One of the leading factors complicating social adaptation after ischemic stroke is cognitive and motor impairment.

AIM: This study aimed to evaluate the effect of rehabilitation using virtual reality technologies and the influence of the main clinical and functional parameters on virtual reality (VR) therapy in patients with different degrees of cognitive decline in the acute period of ischemic stroke.

MATERIALS AND METHODS: This study examined 170 patients diagnosed with ischemic stroke with cognitive decline according to the Montreal Cognitive Assessment. Depending on the volume of therapy, the patients were divided into two groups: group 1 included 120 patients who received additional therapy using VR technologies (62 patients with moderate cognitive impairment, 58 patients with dementia), and group 2 consisted of 50 patients who received only basic therapy and standard methods of early rehabilitation. In group 1, on days 4–5 following basic therapy, rehabilitation using VR was performed. The Barthel Index (BI) scale, Rankin Scale (mRS), and National Institute of Health Stroke Scale (NIHSS) were used to examine cognitive and functional status, and tests were performed to assess cognitive functions, as well as neuroimaging scales ASPECTS, STRIVE, and MTA. The effectiveness of rehabilitation (ΔRE) was measured by the indicator of changes in the parameters of the VR system before and after treatment.

RESULTS: A more significant improvement of the patient’s independence and regression of perceptual and executive functions was demonstrated in group 1 than in the control group. In patients with MCI, significant improvement was observed in all cognitive and functional parameters except semantic information processing, attention, and constructive praxis. In patients with dementia, improvement was noted in NIHSS, speech and amnestic disorders. In group 1, ΔRE was found to be associated with the parameters of perception, attention, semantic information processing, IQCODE, and NIHSS and the presence of hypertension and repeated stroke. In patients with MCI, ΔRE was correlated with lesion size, attention level, BI, mRS, and NIHSS and with age, sex, degree of IQCODE and STRIVE, semantic aphasia, and perceptual impairment in patients with dementia.

CONCLUSION: The present study revealed a polymorphism of factors influencing the effectiveness of VR therapy in patients with varying degrees of cognitive decline. Modern approaches to VR rehabilitation of patients with post-stroke cognitive impairment require the development of individual methods of rehabilitation using immersion environment focused on the structure, etiology, and severity of cognitive deficit considering the degree of the patient’s functional state.

BACKGROUND: Estimating the effectiveness of robotic mechanotherapy is crucial in the rehabilitation of children with cerebral palsy.

AIM: To evaluate the effectiveness of the Walkbot robotic complex (Walkbot, Korea) in children with cerebral palsy.

MATERIALS AND METHODS: The study included 35 patients with infantile cerebral palsy who received courses of rehabilitation therapy based on the state autonomous institution “City Children’s Polyclinic No. 7.” A comparative analysis of the functional motor outcomes between two groups of children with cerebral palsy was performed. Group 1 was treated with locomotor therapy on the Walkbot, whereas group 2 was not prescribed with the apparatus.

RESULTS: The effect of using the Walkbot mechanotherapeutic complex on functional motor outcomes in patients with infantile cerebral palsy was evaluated. Better dynamics of the level of motor skills development on the GMFM-66 scale was noted in group 1 (by 6.8% in group 1 and 4.1% in group 2; p=0.006). The Hauser index (p=0.05) indicated an improvement in locomotor function, which increased the level of independence in everyday life according to the FIM scale (p=0.044), compared to the data of children in the control group. Attaining the effect depends on the number of procedures and total number of rehabilitation courses.

CONCLUSION: Children with cerebral palsy who received the Walkbot therapy have better motor outcomes, primarily relating to locomotor function.

Functional electrical stimulation involves the use of electrical impulses to stimulate muscles during motor activity, particularly in patients with an acute cerebrovascular accident and are undergoing rehabilitation to regain their ability to walk.

This study aimed to examine the existing literature on the use of functional electrical stimulation, focusing on the application methods and stimulation parameters.

The authors analyzed the studies and determined scientifically validated parameters for stimulation and methods of applying functional electrical stimulation. This article provides a summary of key parameters such as frequency, waveform, amplitude, and duration of the electrical pulse and information on the placement of electrodes and synchronization of the pulses with movement, specifically with the gait cycle. Additionally, it covers aspects such as the timing of procedures and frequency and duration of treatment. The currently known aspects, advantages, and limitations of the method are discussed. Notably, several key parameters used in functional electrical stimulation have not been scientifically justified. The criteria for conducting functional electrical stimulation procedures and courses are unclear, and contraindications are reduced as the method evolves. Systems used for implementing functional electrical stimulation vary significantly in their capabilities for setting up work and synchronization with movement.

Considering the importance of rapidly restoring motor functions and the positive impact of functional electrical stimulation on physical and psychological health of neurological patients, further investigation is required to determine optimal parameters for functional electrical stimulation and its application methodology.

Venous thromboembolism is a common complication following spinal cord injury that can significantly aggravate a pre-existing condition and lead to a death. Patients who suffer acute spinal cord injury have a higher prevalence of venous thromboembolism than patients who suffer other traumatic injuries with sparing of the spinal cord. It is important for physical medicine and rehabilitation specialists to have knowledge аbout primary prevention of venous thromboembolism in patients with acute, subacute and chronic spinal cord injury.

This article provides a brief overview of typical venous thromboembolism frequency (leg deep vein thrombosis and pulmonary embolism), pathogenesis peculiarities, venous thromboembolism risk factors and diagnostic considerations. The main attention is given to the primary thromboprophylaxis (methods and duration) depending on the spinal cord injury period and the spinal cord injury level. Further studies are required to clarify the optimal prophylaxis methods and protocols to prevent venous thromboembolism following spinal cord injury.