Сomplex rehabilitation of walking function in central paresis of the lower limb using neuroprosthetic technology

Abstract

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)

Keywords

acute stroke / acute period / angioneurology / botulinum therapy / functional electrical stimulation / rehabilitation / spasticity / walking disorder

References

[1] Stein C, Fritsch CG, Robinson C. Effects of functional electrical stimulation in spastic muscles after stroke: systematic review and meta-analysis of randomized controlled trials. Stroke. 2015;46(8):2197–2205. DOI: 10.1161/STROKEAHA.115.009633

[2] Stein C., Fritsch C.G., Robinson C. Effects of functional electrical stimulation in spastic muscles after stroke: systematic review and meta-analysis of randomized controlled trials // Stroke. 2015. Vol. 46, No. 8. P. 2197–2205. DOI: 10.1161/STROKEAHA.115.009633

[3] Mokienko OA, Suponeva NA. Stroke in adults: central paresis of the upper limb. Clinical recommendations. Moscow: MEDpress-Inform Publisher; 2018. (In Russ.)

[4] Мокиенко О.А., Супонева Н.А. Инсульт у взрослых: центральный парез верхней конечности. Клинические рекомендации. М.: МЕДпресс-Информ, 2018.

[5] Polykova AV, Tokareva DV, Voznyuk IA, Zabirov SSh. The role of early rehabilitation after carotid endarterectomy in acute period of ischemic stroke. Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2018;17(2):98–101. (In Russ.) DOI: 10.18821/1681-3456-2018-17-2-98-101

[6] Полякова А.В., Токарева Д.В., Забиров С.Ш., Вознюк И.А. Роль ранней реабилитации пациентов после каротидной эндартерэктомии в остром периоде ишемического инсульта // Физиотерапия, бальнеология и реабилитация. 2018. T. 17, № 2. 98–101. DOI: 10.18821/1681-3456-2018-17-2-98-101

[7] Khatkova SE, Zavaliy YaP. Non-medical methods in rehabilitation of patients with post-stroke spasticity. Physiotherapist. 2019;(5):44–52. DOI: 10.33920/med-14-1905-08

[8] Хатькова С.Е., Завалий Я.П. Немедикаментозные методы в реабилитации больных с постинсультной спастичностью // Физиотерапевт. 2019. № 5. С. 44–52. DOI: 10.33920/med-14-1905-08

[9] Kovyazina MS, Varako NA, Trofimova AK, et al. Neurofeedback in the rehabilitation of patients with motor disorders after stroke. Fiziologiya cheloveka. 2019;45(4):117–126. DOI: 10.1134/S0131164619040040 (In Russ.)

[10] Ковязина М.С., Варако Н.А., Люкманов Р.Х., и др. Нейробиоуправление в реабилитации пациентов с двигательными нарушениями после инсульта // Физиология человека. 2019. Т. 45, № 4. С. 117–126. DOI: 10.1134/S0131164619040040

[11] Pittock SJ, Moore AP, Hardiman O, et al. A double-blind randomised placebo-controlled evaluation of three doses of botulinum toxin type A in the treatment of spasytic equinovarus deformity after stroke. Cerebrovasc Dis. 2003;15(4):289–300. DOI: 10.1159/000069495

[12] Pittock S.J., Moore A.P., Hardiman O., et al. A double-blind randomised placebo-controlled evaluation of three doses of botulinum toxin type A in the treatment of spastic equinovarus deformity after stroke // Cerebrovasc. Dis. 2003. Vol. 15, No. 4. P. 289–300. DOI: 10.1159/000069495

[13] Johnson CA, Burridge JH, Strike PW, Wood DE, Swain ID. The effect of combined use of botulinum toxin electric stimulation in the treatment of spastic drof foot after stroke: a preliminary investigation. Arch Phys Med Rehabil. 2004;85(6):902–909. DOI: 10.1016/j/apmr.2003.08.081

[14] Johnson C.A., Burridge J.H., Strike P.W., Wood D.E., Swain I.D. The effect of combined use of botulinum toxin electric stimulation in the treatment of spastic drof foot after stroke: a preliminary investigation // Arch. Phys. Med. Rehabil. 2004. Vol. 85, No. 6. P. 902–909. DOI:10.1016/j/apmr.2003.08.081

[15] Klochkov AS, Khizhnikova AE, Kotov-Smolenskiy AM, et al. Modern technologies of functional stimulation in central paresis. Fiziologiya cheloveka. 2019;45(3):129–136. (In Russ.) DOI: 10.17116/kurort201895120-25

[16] Клочков А.С., Хижникова А.Е., Котов-Смоленский А.М., и др. Современные технологии функциональной электростимуляции при центральных парезах // Физиология человека. 2019. Т. 45, № 3. С. 129–136. DOI: 10.17116/kurort201895120–25

[17] Ekusheva EV. Modern technologies and prospects of rehabilitation of patients after ischemic stroke. Neuroscience and Behavioral Physiology 2017;117(12):147–155. (In Russ.) DOI: 10.17116/jnevro2017117121147-155

[18] Екушева Е.В. Современные технологии и перспективы нейрореабилитации пациентов после ишемического инсульта // Журнал неврологии и психиатрии им. С.С. Корсакова. 2017. Т. 117, № 12. C. 147–155. DOI: 10.17116/jnevro2017117121147-155

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Voznjuk I.A., Polyakova A.V., Tokareva D.V.