Possibilities neuroimaging and neurophysiological research methods to objectify rehabilitation potential in patients with ischemic stroke (analytical review of the literature)

Abstract

Cerebral stroke (CS) remains the most important medical and social problem. According to available data, only 25% of stroke survivors return to the premorbid level of daily or work activity, most patients have residual neurological disorders of varying severity. Effective rehabilitation of patients with CS requires not only timely initiation of treatment, but also an individual choice of rehabilitation program. To optimize the rehabilitation strategy in each case, it is necessary to set goals and objectives taking into account the rehabilitation potential (RP) and the prognosis of the patient’s recovery. This paper provides a definition of RP and ways to describe it. The existing neurophysiological methods for assessing the RP of functional recovery after CS, such as electroencephalography, evoked potentials and diagnostic transcranial magnetic stimulation (TMS), are considered. Information about neuroimaging diagnostic methods – computer (CT) and magnetic resonance imaging (MRI) in the context of determining RP is presented. The possibilities of functional and diffusion-t ensor MRI of the brain for assessing RP in various periods of the disease are highlighted in detail. Other possible predictors of the restoration of impaired functions are also considered – the volume and localization of the brain lesion, the patient’s age, cognitive functions and laboratory parameters. Modern complex approaches to the formation of algorithms for the quantitative assessment of RP are described. In particular, the current algorithms for evaluating RP – PREP2 for the upper limb and TWIST for predicting the recovery of walking disorders are described. Currently, there are no generally accepted methods for determining and quantifying RP. The instruments proposed for this purpose are insufficiently sensitive and specific or are not suitable for routine clinical practice.