The effectiveness of comprehensive rehabilitation of patients with fine motor impairment after ischemic stroke

Abstract

BACKGROUND: The consequences of acute cerebrovascular accidents significantly reduce the quality of life and disrupt the professional activity of patients. A number of studies in patients with mild and moderate paresis of the upper limb after ischemic stroke have shown the clinical effectiveness of the use of hardware technologies based on the principle of biofeedback ― a non-drug treatment method using special equipment for recording, amplification and "feedback" physiological information to the patient. AIM: To evaluate the effectiveness of fine motor skills restorationin patients after ischemic stroke using hardware methods with biofeedback, in combination with peripheral electrical myostimulation and basic therapy. MATERIALS AND METHODS: At the Medsi Clinical Hospital, in the personalized rehabilitation department, examinations and treatment and rehabilitation measures were carried out for 57 patients (22 women and 35 men) who had suffered ischemic stroke with motor disorders in the upper limb. Patients were randomized into groups: group 1 (comparison) ― 30 patients who underwent a standard rehabilitation program for neurological disorders, within which peripheral electrical myostimulation (ACorD) N 10 was performed daily in combination with an additional set of exercises for fine motor skills 30 minutes 5 times a week No 20; group 2 (main) ― 27 patients who along with the basic program and peripheral electromyostimulation (ACorD) N 10 daily, underwent biofeedback sessions on the HandTutor device for 30 minutes, 5 times a week No 20. The patients received drug therapy for neurological disorders, they underwent physical therapy exercises, walking treatment on the Lokomat automatic device, mechanotherapy, and sessions with a neuropsychologist. Before and after the end of rehabilitation measures, at 3, 6 and 12 months, the patient’s condition was assessed using the Rivermead Activities of Daily Living scale ― part "hand", the state of hand function was assessed using the "Finger and Wrist Movement Analysis" test on the HandTutor glove (MediTouch, Israel). RESULTS: It has been established that the inclusion of the proposed method in a complex of rehabilitation measures after a stroke contributes to a statistically significant positive dynamics of Rivermead scale indicators (part "hand") and an active increase in the movements of all fingers and wrists by 30–40% within 3–12 months after the start of rehabilitation events. CONCLUSION: The use of hardware methods with biofeedback is a clinically effective approach within the framework of complex rehabilitation of post-stroke patients with impaired function of the upper limb, the positive effect of which is based on the mechanisms of neuroplasticity.