Neuroprosthetic Technology «Bioness» (Exorobot) in the Process of Restoring Motor and Vegetative-Trophic Disorders in Central Paresis of the Upper Limb

Abstract

Disability after a stroke or brain injury is most often associated with impaired movement, speech, swallowing, and reduced cognitive abilities. By the end of the acute period of stroke, paresis in the arm and leg of varying degrees is observed in 80-90 % of survivors.In case of severe paresis, it is advisable to support the function of the limb at the early stages of recovery using modern specialized modifiable devices and methods that provide functional and multimodal stimulation and partial prosthetics. Aim of the study: evaluation of the efficacy of functional electrical stimulation (FES) in a complex of multimodal effects in restoring movement in Stroke patients with upper limb paresis (palcy).Methods. Stimulation and neuroprosthetic methods (FES - “Bioness H200”, RTMs) were used as the main therapeutic program of rehabilitation treatment for patients with motor disorders of the upper limb after an ischemic stroke (n=140). The median period of stroke was 25 [13; 56] days, median age 52 [48; 69] years. The standard methods of diagnosis and treatment of patients with stroke in accordance to the protocol of the Ministry of health of the Russian Federation No. 928 n and 1705 n (2012) were used, as well as scales and questionnaires for assessing the loss of strength and volume of motor disorders, assessing depression and motivation for treatment (Motricity Index), Fugl-Meyer AR, Medical Research Council Weakness Scale, Modified Ashworth Scale (MAS), Beck Depression Inventory; Beck At, Recovery Locus of Control, Patridge C., Johnstone M. Results. The effectiveness of personalized therapy with the use of a neuroprosthesis (“Bioness H200”) in patients in the acute period of ischemic stroke was shown, with the Motrisight index, Fugle-Meier scale being the most sensitive scales. the results depend on thebasic disease characteristics, the most relevant of which were - focus, degree of neurological deficit, personal motivation. The addition using of botulinum toxin allowed eliminating the inhibitory effect of spasticity, which prepared patients for intensive methods of physical rehabilitation. During the follow-up period, no complications were revealed. In 90% of cases, an increase in daily activity was noted. Functional electrical stimulation has significantly increased their level of self-care. The disability complex was initially equally pronounced in all patients, but positive reinforcement in the form of movement of the paretic hand against the background of FES led to a decrease in the severity of depression. In 100%, there was a high motivation to continue the treatment program with neuroprosthetics. Conclusion. The use of a complex of stimulating personalized techniques in the acute period of stroke is justified and safe. The useof FES significantly increases the range of motion in the hand, helps to overcome power paresis, coordination disorders, increases the general level of physical activity of patients after a stroke, motivation for the recovery process and improves the quality of life.