[Dynamics of motor and functional disorders in the early recovery period after ischemic stroke].

Abstract

Currently, strokes are on the 2^nd place on prevalence and mortality of the population, and an increase in the proportion of disabled people after cerebral stroke is noted. Disability is caused by motor deficiency of the paretic extremities, which impairs the patient's mobility, limits his participation in daily living, reduces the chances of returning to professional activity in 1/2 of patients after stroke. Due to this, the elimination of motor disorders and recovery of functional activity of the paretic extremities are the important aspects of post-stroke patients' medical rehabilitation.

Objective: To study the dynamics and degrees of motor and functional disorders in patients with hemiparesis during the first 6 months after ischemic stroke under the impact of medical rehabilitation, including kinesiotherapy, physiotherapy and transcranial magnetic stimulation.

Material and methods: Motor disorders and functional limitations were assessed using validated scales (Fugl-Meyer, Medical Research Committee Scale, Modified Ashworth Scale of muscle spasticity, Modified Frenchay scale, Wolf Motor Function Test, Action Research Arm Test, Rivermead mobility index, Hauser ambulation index, Functional Independence Measurement). Diagnostic and therapeutic transcranial magnetic stimulation was performed using the «Neuro-MS/D» magnetic stimulator.

Results: The dynamics of types and degrees of motor and functional disorders were evaluated in 113 patients with hemiparesis in the first 6 months after ischemic stroke. Severe disorders of the tone and strength characteristics of paretic muscles and limitation of movement in the joints of paretic extremities have been found in 2/3 of patients. The balance function (it is difficult to maintain a vertical position of the body) was impaired in 1/2 of patients. The correlations of electrophysiological indicators (diagnostic transcranial magnetic stimulation and surface electromyography) with clinical ones (degree of paresis, tone of paretic muscles, motor abilities and motor skills of the paretic hand, independence in daily living) have been determined. Positive impact of medical rehabilitation, including kinesiotherapy, physiotherapy and transcranial magnetic stimulation, on the strength of paretic muscles of the hand and leg, mobility of patients, walking function, activity of the paretic hand (transfer by the hands, manipulation of extremities' segments and objects) has been revealed. Electrophysiological investigation has shown that the functional activity of the paretic muscles increased.

Conclusion: Severe motor and functional disorders, most pronounced in distal segments of the extremities (lack of movements in 14-26% of cases), are prevalent in the first six months after ischemic stroke in the carotid system. The regression of motor disorders leads to an enhancement of functional abilities (use of the paretic extremities for the realization of various motor actions) under the impact of rehabilitation.