Early Motor Rehabilitation Research Articles

Opportunities, Risks, Strengths and Weaknesses of Robotic Systems in Early Neurological Rehabilitation.

Given the conference's focus on innovative healthcare solutions, our investigation into robotic assistance systems highlights crucial advancements in early motor rehabilitation, aligning closely with emerging healthcare priorities. In combination with conventional therapy, the assistance systems offer new possible therapy programs. They can be used to mobilize and move patients as early as possible. The paper discusses the possibilities that arise from their use and considers the obstacles that arise. As part of a qualitative survey, nine expert interviews from different fields were conducted to guide them on robotic assisted living systems. The results obtained were summarized by coding into categories and evaluated. Our analysis of 148 coding points from nine expert interviews reveals significant insights into the strengths and weaknesses of robotic systems in neurorehabilitation. Each point was meticulously categorized to reflect its impact on both practice and patient outcomes, highlighting the practical implications of our findings. The results of the survey and the literature indicate a positive effect of robotic assistance systems in early rehabilitation. Their use requires intensive monitoring and studies on the long-term application of the systems.

Treatment of patients with caudal regression syndrome: a systematic review of the literature

Objective. To analyze and summarize the data of modern literature on the issues of surgical treatment and natural course of the spine and spinal cord pathology in patients with various types of caudal regression syndrome (CRS).Material and Methods. A systematic review of the literature on the issue of treatment of the spine and spinal cord pathology in patients with CRS was performed. Selection criteria were: articles for the period 2002–2022, original studies of populations/patients with various forms of CRS with a description of treatment methods and long-term results of treatment or observation. A total of 28 articles on the treatment of various forms of CRS with the described results of treatment of 212 patients were analyzed: 29 patients with CRS in combination with open neural tube defects and 183 patients with closed forms of CRS. Evaluation criteria included number of patients, gender, type of spinal cord pathology, type of sacral agenesis, presence of the spine and lower extremities deformities, concomitant pathology, operations performed and their complications, and results.Results. The studied patients underwent the following surgeries on the spine and spinal cord: untethering of the spinal cord, correction and stabilization surgeries on the spine, plasty of the spinal cord herniation, plasty of the terminal meningocele, and removal of the presacarial volumetric mass. The greatest number of complications occurred after operations on the spine and sacrum. The majority of patients (67 %) with sacral agenesis by the end of the follow-up period (average 14 years) walked independently or with the help of devices, and a minority of them (33 %) could not walk. More than half of patients with CRS (67 %) had a neurogenic bladder, urinary incontinence, or suffered from a chronic urinary tract infection. Fecal incontinence and constipation were less common (46 %).Conclusions. Patients with CRS have a good potential for improvement/recovery of walking and pelvic organ dysfunction. This is extremely important to timely carry out multimodality treatment of patients with CRS who have neurosurgical, orthopedic, urogenital and colorectal problems in CRS, and to start early motor rehabilitation and physiotherapy.

European Academy of Neurology and European Federation of Neurorehabilitation Societies guideline on pharmacological support in early motor rehabilitation after acute ischemic stroke (Translated from English by Natalia Kuprinenko)

European Academy of Neurology and European Federation of Neurorehabilitation Societies guideline on pharmacological support in early motor rehabilitation after acute ischemic stroke (Translated from English by Natalia Kuprinenko)

European Academy of Neurology and European Federation of Neurorehabilitation Societies guideline on pharmacological support in early motor rehabilitation after acute ischaemic stroke.

Early pharmacological support for post-stroke neurorehabilitation has seen an abundance of mixed results from clinical trials, leaving practitioners at a loss regarding the best options to improve patient outcomes. The objective of this evidence-based guideline is to support clinical decision-making of healthcare professionals involved in the recovery of stroke survivors. This guideline was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. PubMed, Cochrane Library and Embase were searched (from database inception to June 2018, inclusive) to identify studies on pharmacological interventions for stroke rehabilitation initiated in the first 7days (inclusive) after stroke, which were delivered together with neurorehabilitation. A sensitivity analysis was conducted on identified interventions to address results from breaking studies (from end of search to February 2020). Upon manually screening 17,969 unique database entries (of 57,001 original query results), interventions underwent meta-analysis. Cerebrolysin (30ml/day, intravenous, minimum 10days) and citalopram (20mg/day, oral) are recommended for clinical use for early neurorehabilitation after acute ischaemic stroke. The remaining interventions identified by our systematic search are not recommended for clinical use: amphetamine (5, 10mg/day, oral), citalopram (10mg/day, oral), dextroamphetamine (10mg/day, oral), Di-Huang-Yi-Zhi (2×18g/day, oral), fluoxetine (20mg/day, oral), lithium (2×300mg/day, oral), MLC601(3×400mg/day, oral), phosphodiesterase-5 inhibitor PF-03049423 (6mg/day, oral). No recommendation 'for' or 'against' is provided for selegiline (5mg/day, oral). Issues with safety and tolerability were identified for amphetamine, dextroamphetamine, fluoxetine and lithium. This guideline provides information for clinicians regarding existing pharmacological support in interventions for neurorecovery after acute ischaemic stroke. Updates to this material will potentially elucidate existing conundrums, improve current recommendations, and hopefully expand therapeutic options for stroke survivors.

Intensive In-Bed Sensorimotor Rehabilitation of Early Subacute Stroke Survivors With Severe Hemiplegia Using a Wearable Robot.

Rehabilitation for stroke survivors with severe motor impairment remains challenging. Early motor rehabilitation is critical for improving mobility function post stroke, but it is often delayed due to limited resources in clinical practice. The objectives of this study were to investigate the feasibility and effectiveness of early in-bed sensorimotor rehabilitation on acute stroke survivors with severe hemiplegia using a wearable ankle robot. Eighteen patients (9 in the study group and 9 in the control group) with severe hemiplegia and no active ankle movement were enrolled in acute/subacute phase post stroke. During a typical 3-week hospital stay, patients in the study group received ankle robot-guided in-bed training (50 minutes/session, 5 sessions/week), including motor relearning under real-time visual feedback of re-emerging motor output, strong passive stretching under intelligent control, and game-based active movement training with robotic assistance. Whereas the control group received passive ankle movement in the mid-range of motion and attempted active ankle movement without robotic assistance. After multi-session training, the study group achieved significantly greater improvements in Fugl-Meyer Lower Extremity motor score (p = 0.007), plantarflexor strength (p = 0.009), and active range of motion (p = 0.011) than controls. The study group showed earlier motor recovery for plantarflexion and dorsiflexion than the control group (p < 0.05). This study showed that in-bed sensorimotor rehabilitation guided by awearable ankle robot through combining motor relearning in real-time feedback, strong passive stretching, and active movement training facilitated early motor recovery for stroke survivors with severe hemiplegia in the acute/subacute phase.

Clinical and laboratory assessment of the effectiveness of early rehabilitation of patients with stroke using assistive robotic tools

Background. Using external robotic tools in rehabilitation of patients after stroke could activate neuroplasticity mechanisms, thus reducing the ischemic area and improving the neurological outcome of the disease.Aim. To evaluate the effectiveness of early rehabilitation of stroke patients in Tomsk Regional Stroke Center using assistive robotic tools by correlational analysis of clinical and laboratory biomarkers of brain neuroplasticity.Materials and methods. The study included 68 patients who suffered from stroke of the middle cerebral artery. Early rehabilitation was carried out in Tomsk Regional Stroke Center using assistive robotic tools according to the protocol. Neurotrophic factors in blood serum were measured by the enzyme-linked immunosorbent assay. The severity of neurological disorders was characterized based on the Fugl – Meyer assessment scale (FMA).Results. The clinical effectiveness of early motor rehabilitation in Tomsk Regional Stroke Center is confirmed by the statistically significant increase on the FMA scale by 5.2 ± 2.4 points (p = 0.008). Positive association between neurotrophic factors in blood serum and FMA total score enables to consider the resulting data as an evidence of neuroplasticity activation associated with the use of robotic electromechanical technologies.

Safety of Balloon Kyphoplasty in the Treatment of Thoracic Osteoporotic Vertebral Compression Fractures in Vietnamese Patients.

BackgroundThe evidence for the efficacy and safety of balloon kyphoplasty (BKP) in treating the Vietnamese patients is sparse. There is no convincing evidence regarding BKP's efficacy in Vietnamese patients, especially in the patients with thoracic osteoporotic vertebral compression fractures (VCFs). This article aims to evaluate the outcomes of restoring the body height of the compressed thoracic vertebrae in patients undergoing BKP.MethodsWe prospectively enrolled 65 consecutive patients with thoracic VCFs (73 vertebrae) due to osteoporosis who were treated with BKP between June 2018 and May 2019.ResultsA trocar was inserted through the pedicle in 84.9% (62/73) and beside the pedicle in 15.1% (11/73). The mean amount of mixed cement injected was 4.1 ± 1.1 mL (range, 1.5–7 mL). Cement leakage was radiographically confirmed in 30.8% of 65 patients. Among patients with complications caused by cement extravasation, the leakage was through the anterior margin of the vertebrae in 15.4%, through the vertebral disc in 12.3%, and through the posterior margin of the vertebrae in 3.1%. In the last 3.1% of patients, there was no clinically notable lesions of the nerve roots or spinal cord. The mean visual analog scale score decreased significantly from 7.3 ± 1.1 preoperatively to 3.3 ± 0.6 at 24 hours after surgery, and then to 1.2 ± 1.1 at 3 months after surgery (p < 0.01). The mean reduction in Cobb angle measured on standing radiographs after treatment was 3.7°, showing statistical significance (p < 0.01).ConclusionsBKP is a minimally invasive treatment effective for immediate pain relief, early motor rehabilitation, and humpback correction. The present study provided convincing evidence to support the use of BKP by spine surgeons and clinical specialists in treating osteoporotic thoracic VCFs in Vietnamese patients.

Intermittent theta burst stimulation applied during early rehabilitation after stroke: study protocol for a randomised controlled trial

IntroductionIntermittent theta burst stimulation (iTBS) applied to primary motor cortex (M1) has been shown to modulate both the excitability and connectivity of the motor system. A recent proof-of-principle study, based...

Персонализированный подход к составлению программы ранней двигательной реабилитации детей с позвоночно-спинномозговой травмой с учетом толерантности к физической нагрузке

Персонализированный подход к составлению программы ранней двигательной реабилитации детей с позвоночно-спинномозговой травмой с учетом толерантности к физической нагрузке

The motor activity in acute cerebral stroke based on the Performance Oriented Mobility Assessment test modified by M. T inetti (1986), functional stress tests and screening assessment of visual-spatial disorders

Objective. The article presents the survey data of 80 patients in the acute period of cerebral stroke who were treated in the department of the primary vascular center. Design and methods. Upon recommendations of the motor activity, the patients with acute stroke were screened for the presence of neglect. The choice of motor activity was based on the Performance Oriented Mobility Assessment test in the modification of M. Tinetti (1986) and the results of functional stress tests. Results. There were no complications or falls at the hospital when adequate vegetative support and a high score at Performance Oriented Mobility Assessment in the modification of M. Tinetti (1986) were present, as well as in the absence of visual-spatial inability. The patients with the significant visual-spatial neglect showed higher risk of falls, even with adequate vegetative support and postural stability. Results. We demonstrated the possibility, as well as the prognostic value of the Performance Oriented Mobility Assessment in the modification of M. Tinetti (1986) and functional stress tests along with the assessment of visual-spatial neglect in planning the early motor rehabilitation of patients with cerebral stroke. In addition, we developed an algorithm for the motor rehabilitation planning.

Personalized approach to working up an early motor rehabilitation program for children with vertebral column and spinal cord injury, taking into account exercise tolerance

The relevance of rehabilitation of children with vertebral column and spinal cord injury (VCSCI) is due to the steady growth in the number of such patients. The mandatory conditions for early motor rehabilitation are to size efforts, to exclude fatigue and overtraining, and to gradually increase loads. The priority tasks of drawing up an individual motor program are to determine the rehabilitation abilities of a child and his/her willingness to perform the proposed load. To investigate whether the motor rehabilitation program can be personalized for children with severe VCSCI on the basis of estimation of exercise tolerance. The investigation enrolled 25 patients with VCSCI (12 people with superior paraparesis or inferior paraplegia and 13 with inferior paraparesis or inferior paraplegia); their mean age was 12.1±5.0 years. An individual active motor rehabilitation program was worked out for all the patients according to the results of exercise tolerance testing. The latter was performed using ergospirometry to determine the maximum oxygen consumption (VO2 max) and the time to reach the anaerobic threshold. After a rehabilitation cycle, all the patients showed an increase in VO2 max and time to reach the anaerobic threshold. The obtained results about the increase in VO2 max with active exercises and the expansion of the aerobic corridor in both patient groups suggest that the exercise tolerance was enhanced due to increases in muscle strength and total body endurance. By the end of the rehabilitation cycle, all the patients displayed an increase in the motor density of exercises to 29.2±4.3 (64.9%) of the 45 min. Passive load decreased to 15.8±4.3 (35.1%) min. Assessment of the individual capabilities of a patient allows one to personalize the motor rehabilitation program. Ergospirometry is a technique to monitor the adequacy of the proposed program.

ROBOTIC MECHANOTHERAPY IN REHABILITATION OF CHILDREN WITH CEREBRAL PALSY AFTER COMBINED ORTHOPEDIC SURGERY

The article represents a clinical research of 20 patients with infantile cerebral paralysis, who had got an early motor rehabilitation after complex orthopedic and neurosurgical treatment. The comparative analysis of results after traditional exercise therapy and mechanotherapy was carried out with the use of robotic system “Lokomat”. It was set up that early use of robotized mechanotherapy during postoperative period reduces significantly the time of motor rehabilitation in comparison with traditional exercise therapy.

Assisted leg displacements and progressive loading by a tilt table combined with FES promote gait recovery in acute stroke

Here we developed and tested a novel system for early motor rehabilitation in acute stroke when patients are unable to stand and walk without assistance. Stepping performance may be largely facilitated by providing treatment in the supine position on a tilt table using step-synchronized functional electrical stimulation (FES) with assisted leg movements and progressive limb loading. Sixty-one individuals with acute stroke were randomly assigned to two groups, experimental and control. The first group received both a conventional therapy and FES-therapy combined with progressive limb loading, whereas the control group received a conventional therapy only. Changes after treatment were assessed using clinical scores and neurophysiological measurements of movement performance. After treatment, there was an improvement of the clinical scores, muscle forces and everyday life activity performance in both groups, however, significantly higher in the experimental group. Active rhythmic movements of the non paretic leg often provoked muscle activity in the paretic leg as well as there was a reduction of the contralateral leg muscle contraction during paretic leg movements. The developed FES and leg displacement-assisted therapy facilitates a smooth transition to walking in the vertical position and increases the patient's functional abilities and the effectiveness of rehabilitation.

The influence of early rehabilitation on motor disorder after cerebral hemorrhage

Objective To Busses8 the influence of early rehabilitation on motor disorder after cerebral hemorhage.Methods 60 case8 of cerebral hemorrhage were divided into two groups.One group received basic therapy.Except for basic therapy,early motor rehabilitation and education of life ability were used in the other group.The damnification of nerval function and life ability were estimated when patients entered the hospital and after4 weeks.Data were contrasted in group and between groups.Results The two groups had remarkable differences in life ability and motor function(P<0.01).The improve of the rehabilitation group Was very evidonee.Conclusion Early rehabilitation Was much better than single medicine therapy in the improvement of motor function and life ability.Rehabilitation in the 24 hours after cerebral hemorrhage Wma feasible and resultful.Methods in our hospital were very simple and effective. Key words: Rehabilitation; Stroke; Motor disorder