The comprehensive step-by-step rehabilitation of the patients after acute disturbances of the cerebral circulation

Abstract

The objective of the present study was to evaluate the therapeutic effectiveness of the comprehensive one- and two-stage rehabilitation including the application of mirror therapy and orthetics on an individual basis. The study included 125 patients (66 men and 59 women) at the medium age of 57 (52; 63) years who had undergone the acute disorders of cerebral circulation (the diagnosis was verified based on the results of CT or MRI of the brain). The localization of stroke in the basin of the left middle cerebral artery was documented in 41,1% of the patients and in the basin of the right middle cerebral artery in 58,9% of them. The severity of neurologic deficit was estimated with use of the Stolyarova scale, Ashfort spastic scale, the Timed Walking Test with pegs and nine holes, the Bartel index of the activities of the daily life. Also estimated were the severity of anxiety and depressive disorders (based on the Spilberger and Beck scales). The state of the cognitive functions was evaluated by means of the mini-mental state examination (MMSE) and the Clock Drawing Test). The Medical Outcomes Study Short Form-36 (scores of MOS SF-36) was employed to estimate the quality of life of the patients. The rehabilitation of the patients was conducted either in 1 or 2 stages, i.e. during the early and (or) late post-treatment periods. In the early period, the medicamental treatment, therapeutic physical exercises, paraffinic and ozoceritic applications, hand massage, electrostimulation of the antagonists of the spastic muscles as well as mirror therapy were used. The rehabilitative process during the late post-treatment period was completed using orthetics of the affected (paretic) hand on an individual basis. The two-stage medical rehabilitation exercised during the early post-treatment period after the stroke with the application of mirror therapy promoted the decrease of the degree of paresis in the affected hands from 2.50 (1.68; 3.19) to 1,12 (0.81; 1.75) scores (p<0,001) and the increase of the motor activity of the affected extremities (the volume of movements, walking skills, the ability to fulfil biomechanical tests). The program of the comprehensive rehabilitation based on the use of orthetics of the paretic hand on an individual basis made it possible to achieve the maximum lowering of muscle hypertonia in the hand affected by paresis (to less than 0.50 scores, i.e. by 0.625 scores) [0.06; 0.75] (p<0.05). The maximum efficiency (83%) was achieved by means of two-stage rehabilitation. The comprehensive two-stage medical rehabilitation of the patients who had undergone the acute disorder of cerebral circulation with use of mirror therapy in the combination with orthetics on an individual basis produces the high therapeutic effect, with the effectiveness of the treatment amounting to 83% and the considerable positive dynamics of motor functions documented in 59% of the patients.