REHABILITATION TREATMENT OF PATIENTS IN THE ACUTE PERIOD OF ISCHEMIC STROKE

Abstract

Purpose of the study is to evaluate the effectiveness of using robotic mechanotherapy in patients with central hemiparesis in the acute period of ischemic stroke. The study's objective Assess the dynamics of restoration of voluntary movements in the acute period of ischemic stroke during rehabilitation treatment using RM. Assess the dynamics of changes in activity in patients’ daily lives during rehabilitation measures using RM. Assess the impact of a course of rehabilitation treatment using RM on indicators of central and cerebral hemodynamics. Develop principles for the differential use of RM in patients in the acute period of ischemic stroke. Indications for the differentiated use of RM for the rehabilitation treatment of patients with central paralysis have been determined. Recommendations are given for selecting training parameters depending on the data from the initial clinical and instrumental examination of the patient. The use of the developed comprehensive program made it possible to ensure a more rapid regression of movement disorders in patients after an ischemic stroke. In the acute period of ischemic stroke, RM is more effective in restoring motor functions and activity in daily life than standard methods of restorative treatment. Findings. The use of robotic mechanotherapy in the complex treatment of patients in the acute period of ischemic stroke is more effective in restoring motor functions and allows reducing the degree of central paresis by the end of rehabilitation treatment by 2.1 points; the use of standard treatment and rehabilitation methods alone reduces paresis by only 1.2 points on a six-point scale for the degree of paresis. Comprehensive treatment using robotic mechanotherapy is more effective in restoring patient activity in everyday life (Bartel's activity index in everyday life increased by 27.4 points) compared to the standard rehabilitation program (Bartel's index increased by 14.8 points). The practical value The use of robotic mechanotherapy is indicated for patients with motor disorders (any degree of paresis) and stable central hemodynamics as a result of treatment on days 4-5 after the acute period of ischemic stroke. For each patient, depending on the degree of paresis, it is advisable to develop an individual training program on the “NuStep” robotic mechanotherapy complex. Patients with an initially pronounced paresis — from 0 to 2 points should undergo a PM session with a degree of active participation of the patient of no more than 40% and a step-by-step speed of 40 steps per minute with an increase in speed to 44-46 steps per minute. For patients with paresis from 2 to 4 points, it is recommended to conduct a session of robotic mechanotherapy with a degree of active participation of up to 80% and a starting step-by-step speed of 46-48 steps per minute with an increase in speed to 50-56 steps per minute.