COMPLEX NEUROREHABILITATION OF POST-STROKE PATIENTS

Relevance. There are studies on the positive effect of electric current on neuronal excitability and activity of the cerebral cortex, depending on the chosen mode. But it is not known whether there will be a positive clinical effect from transcranial electrical stimulation of the brain in patients who have suffered an ischemic stroke. Objective: evaluation of the clinical effectiveness of the complex method of neurorehabilitation of post-stroke patients. Material and methods. Treatment of 150 patients with ischemic type of acute violation of cerebral circulation was carried out. The total sample was randomly divided into four clinical groups: І (n=30) – traditional therapy, ІІ (n=40) – application against the background of traditional therapy of neuroprotection in the acute and early recovery period with peptidergic compounds (cerebrolysin 40 ml per day), ІІІ ( n=40) – application of traditional therapy with transcranial micropolarization of the brain, IV (n=40) – application against the background of traditional therapy of combined neuroprotection in the acute and early recovery period with peptidergic compounds in combination with micropolarization of the brain. All patients during the observation period were repeatedly assessed the motor function of the upper limb using the Action Research Arm Test (ARAT), in its own modification with the assessment of the extension function of the fingers of the hand. Additionally, functional recovery after a stroke was assessed using the STREAM (Stroke Rehabilitation Assessment of Movement) scale, assessment of the function of the upper limb using the Fugl-Meyer FMA-UE test and the lower limb using the FMA-LE test. Disturbances in the motor-coordination sphere were additionally assessed using the stabilometry method on the ST-150 platform, using the following subtests: Romberg test, combined coordination-motor test, static test, dynamic test, as well as the foot reception test. Statistical processing was performed by the method of variance analysis. Results. As a result of rehabilitation measures, locomotion function and fine motility of the upper limb are restored in all patients. Recovery of upper extremity fine motility and stato-dynamic indicators in patients who received neuroprotective effects during the treatment of stroke is permanent. Positive dynamics are monitored throughout the entire period of catamnetic observation. The use of peptidergic drugs has a greater neurorehabilitation effect than the isolated use of micropolarization. The combined use of micropolarization and peptidergic metabolic support in patients with ischemic stroke significantly improves the functional results of rehabilitation at all stages of observation. According to the FMA-UE test, statistically significant differences compared to controls were observed in the subtests of mobility in the carpal joint and fingers of the hand, as well as voluntary movements with synergy. In patients of the I group, the score on the AII subscale was 15.2 ± 0.2 points, in the II group – 17.3 ± 0.3 points, in the III group – 17.3 ± 0.4 points, and in patients in the IV group – 17, 2±0.3 points (p<0.05). The score on subscale B (mobility of the wrist) for patients of group I was 8.2±0.1 points, group II – 9.0±0.1 points, group III – 9.4±0.1 points, group IV – 9.5±0.1 points (p<0.05). According to subscale C (mobility of the fingers of the hand), the average score in the I group was 11.8±0.2 points, in the II group – 13.0±0.3 points, in the III group – 13.5±0.2 points, and in the IV group – 13.6±0.2 points (p<0.05). According to the data of the FMA-LE test in domain EII (voluntary movements with synergy) in the control (I) group one year after ischemic stroke, the score corresponded to the level of 10.3±0.3 points, in the II group - 13.0±0.4 points, in group III – 13.5±0.3 points, in group IV – 13.6±0.4 points (p<0.05). For the EIII domain (voluntary movements with mixed synergy), the indicators increased to 2.8±0.1 points in the I group, to 3.2±0.1 points in the II group, to 3.3±0.1 points in the III group, up to 3.5±0.1 points – in the IV group (p<0.05). The total FMA-LE score was 74.2±2.4 points for the I group, 78.5±2.6 points for the II group, 79.5±3.2 points for the III group, and 80 for the IV group 80.7±2.5 points (p<0.05). Conclusions. As a result of rehabilitation measures, all patients recover locomotion function, fine motility of the upper limb. The greatest increase in indicators is characteristic of the EFAT subtest, which evaluates the function of straightening the fingers of the hand.The use of peptidergic drugs has a greater neurorehabilitation effect than the isolated use of micropolarization. The combined use of micropolarization and peptidergic metabolic support in patients with ischemic stroke significantly improves the functional results of early rehabilitation

COMPLEX NEUROREHABILITATION OF POST-STROKE PATIENTS

Relevance. There are studies on the positive effect of electric current on neuronal excitability and activity of the cerebral cortex, depending on the chosen mode. But it is not known whether there will be a positive clinical effect from transcranial electrical stimulation of the brain in patients who have suffered an ischemic stroke.&#x0D; Objective: evaluation of the clinical effectiveness of the complex method of neurorehabilitation of post-stroke patients.&#x0D; Material and methods. Treatment of 150 patients with ischemic type of acute violation of cerebral circulation was carried out. The total sample was randomly divided into four clinical groups: І (n=30) – traditional therapy, ІІ (n=40) – application against the background of traditional therapy of neuroprotection in the acute and early recovery period with peptidergic compounds (cerebrolysin 40 ml per day), ІІІ ( n=40) – application of traditional therapy with transcranial micropolarization of the brain, IV (n=40) – application against the background of traditional therapy of combined neuroprotection in the acute and early recovery period with peptidergic compounds in combination with micropolarization of the brain.&#x0D; All patients during the observation period were repeatedly assessed the motor function of the upper limb using the Action Research Arm Test (ARAT), in its own modification with the assessment of the extension function of the fingers of the hand. Additionally, functional recovery after a stroke was assessed using the STREAM (Stroke Rehabilitation Assessment of Movement) scale, assessment of the function of the upper limb using the Fugl-Meyer FMA-UE test and the lower limb using the FMA-LE test.&#x0D; Disturbances in the motor-coordination sphere were additionally assessed using the stabilometry method on the ST-150 platform, using the following subtests: Romberg test, combined coordination-motor test, static test, dynamic test, as well as the foot reception test. Statistical processing was performed by the method of variance analysis.&#x0D; Results. As a result of rehabilitation measures, locomotion function and fine motility of the upper limb are restored in all patients. Recovery of upper extremity fine motility and stato-dynamic indicators in patients who received neuroprotective effects during the treatment of stroke is permanent. Positive dynamics are monitored throughout the entire period of catamnetic observation.&#x0D; The use of peptidergic drugs has a greater neurorehabilitation effect than the isolated use of micropolarization. The combined use of micropolarization and peptidergic metabolic support in patients with ischemic stroke significantly improves the functional results of rehabilitation at all stages of observation.&#x0D; According to the FMA-UE test, statistically significant differences compared to controls were observed in the subtests of mobility in the carpal joint and fingers of the hand, as well as voluntary movements with synergy. In patients of the I group, the score on the AII subscale was 15.2 ± 0.2 points, in the II group – 17.3 ± 0.3 points, in the III group – 17.3 ± 0.4 points, and in patients in the IV group – 17, 2±0.3 points (p&lt;0.05). The score on subscale B (mobility of the wrist) for patients of group I was 8.2±0.1 points, group II – 9.0±0.1 points, group III – 9.4±0.1 points, group IV – 9.5±0.1 points (p&lt;0.05). According to subscale C (mobility of the fingers of the hand), the average score in the I group was 11.8±0.2 points, in the II group – 13.0±0.3 points, in the III group – 13.5±0.2 points, and in the IV group – 13.6±0.2 points (p&lt;0.05).&#x0D; According to the data of the FMA-LE test in domain EII (voluntary movements with synergy) in the control (I) group one year after ischemic stroke, the score corresponded to the level of 10.3±0.3 points, in the II group - 13.0±0.4 points, in group III – 13.5±0.3 points, in group IV – 13.6±0.4 points (p&lt;0.05). For the EIII domain (voluntary movements with mixed synergy), the indicators increased to 2.8±0.1 points in the I group, to 3.2±0.1 points in the II group, to 3.3±0.1 points in the III group, up to 3.5±0.1 points – in the IV group (p&lt;0.05). The total FMA-LE score was 74.2±2.4 points for the I group, 78.5±2.6 points for the II group, 79.5±3.2 points for the III group, and 80 for the IV group 80.7±2.5 points (p&lt;0.05).&#x0D; Conclusions. As a result of rehabilitation measures, all patients recover locomotion function, fine motility of the upper limb. The greatest increase in indicators is characteristic of the EFAT subtest, which evaluates the function of straightening the fingers of the hand.The use of peptidergic drugs has a greater neurorehabilitation effect than the isolated use of micropolarization. The combined use of micropolarization and peptidergic metabolic support in patients with ischemic stroke significantly improves the functional results of early rehabilitation.</jats:p

Оценка качества оказания инсультной помощи в стационарах по данным реестра RES-Q

Реестр качества лечения инсульта (REgistry of Stroke Care Quality, RES-Q) позволяет оценить качество оказания помощи больным с инсультом в стационарах и сравнить ее с качеством в других странах. Цель исследования. Оценить качество оказания стационарной помощи больным с мозговым инсультом в Украине. Материалы и методы. С 2017 года в реестр RES-Q внесена информация по 14 305 пациентам из 90 больниц Украины. Средний возраст больных составил 68 лет. 85,08 % больных были с ишемическим инсультом, 10,53 % — с внутримозговыми геморрагиями, 1,98 % — с субарахноидальным кровоизлиянием, 0,01 % — с венозным тромбозом, 0,27 % — с криптогенным инсультом, 2,13 % — с транзиторной ишемической атакой. У 19,33 % пациентов мозговой инсульт был повторным. Результаты. В инсультных отделениях лечилось 67,9 % больных, остальные — в отделениях реанимации, общей неврологии, нейрохирургии. КТ, МРТ проведены 92,1 % больных. Тяжесть инсульта по шкале NIHSS была оценена у 88,5 % больных (средний балл — 9). Тест на дисфагию проведен 86,71 % больных. Реканализация проведена 5,94 % пациентов с ишемическим мозговым инсультом (тромболитическая терапия — 5,33 %, механическая тромбэктомия — 0,61 %). Гемикраниэктомия проведена у 0,29 % пациентов. Удаление интракраниальной гематомы выполнено у 2,7 % пациентов с внутримозговыми геморрагиями. Реабилитационную помощь получили 71,98 % больных. Выводы. Проведение анализа реестра RES-Q позволило на небольшом количестве пациентов (5 % общего числа больных с мозговым инсультом за 3 года в Украине) оценить качество лечения и признать, что оно требует значительного улучшения и изменений в организации помощи больным.</jats:p