Оцінка впливу активної реабілітації в схемі комплексного лікування на відновлення моторних порушень після мозкового півкульового ішемічного інсульту

Abstract

Cerebral stroke is a «global epidemic», which occupies the leading place in the structure of the causes of disability of the adult population in most countries, having great medical, social, and economic significance. Therefore, this problem is urgent worldwide, being a priority area of the research, which is constantly explored. The earliest possible start of rehabilitation measures improves functional output and reduces the risk of recurrent stroke. Activation and rehabilitation of patients with stroke should begin from the first days of the patient’s stay at the stroke department, immediately after stabilization of the basic vital functions (breath and hemodynamics). The use of international standardized scales is recommended to assess the functional status of the patient, screening, and dynamic diagnosis of motor disorders. The purpose of the study was to evaluate the impact of active rehabilitation treatment in the scheme of comprehensive therapy of patients with cerebral hemispheric ischemic stroke on the dynamics of recovery of motor disorders, and to study their correlations. Materials and methods. The study enrolled 138 patients: 30 healthy individuals (n = 30) and 108 people with cerebral hemispheric ischemic stroke (n = 108), who were divided into two groups: the first group (n = 48), whose treatment generally followed the «classical» measures with the use of medicinal therapy in accordance with the current clinical protocol of medical care for patients with ischemic stroke and the second group (n = 60), in which patients were additionally prescribed and given two courses of rehabilitation using active rehabilitation methods after the first and the third examinations. Results and discussion. The screening was performed using standardized diagnostic scales to determine: stroke severity (National Institutes of Health Stroke Scale), post-stroke functional capacity (Modified Rankin Scale), index of daily activity and self-care ability (Barthel Activities of Daily Living Index), balance impairment (Berg Balance Scale), clinical assessment of spasticity (Modified Ashworth Scale) after acute ischemic cerebrovascular accident. Verification of indicators was performed on days 3-7, day 30, day 90, day 180 after cerebral hemispheric ischemic stroke. In the course of the research, we used modern statistical methods and analyzed the structure of motor disorders before and after treatment, determined the reliability of changes in indicators that demonstrate the dynamics of functional recovery under the influence of active rehabilitation, examined the correlations of motor disorders in the study groups. Conclusion. The obtained results show that the use of active rehabilitation methods in the scheme of comprehensive treatment of patients in acute and recovery periods of cerebral hemispheric ischemic stroke significantly increases the efficiency of recovery of motor functions after the acute cerebral accident