Early Recovery Period Of Ischemic Stroke Research Articles

The Use of Enhanced External Counterpulsation in Complex Medical Rehabilitation of Stable Coronary Heart Disease in Patients Permanently Residing in Humid Subtropics

Aim. To study the dynamics of overall tolerance in patients in the early recovery period of ischemic stroke (IS) with mild and moderately severe paresis, to evaluate the effect of aerobic training in this group of patients on exercise tolerance during inpatient treatment as of Compulsory Medical Insurance (CMI). Material and methods. The first group of 30 patients were examined (17 women, 13 men, the average age – 60,6±6,45 years old) during the 4-6 week of IS. Total points of the FIM scale were 118±5,2 /121,8±4,5. The second group- control group consisted of 30 patients with chronic cerebral ischemia (CCI). The following were mainly dominated among the vascular risk factors in both groups of patients: atherosclerosis of brachiocephalic artery of various degrees of severity poorly controlled arterial hypertension, smoking, dyslipidemia. Physical exercise tolerance was assessed by cardiopulmonary testing on a bicycle ergometer using the Quark CPET spiroergometer system from COSMED (Italy). The peak oxygen consumption (VO2 peak), the maximum load performed in metabolic units (MET), the percentage of the proper maximum oxygen consumption (% pred VО2 peak) with constant ECG monitoring, blood pressure during the exercise test were evaluated. Patients with stroke received aerobic training during rehabilitation treatment – 10-12 sessions according to the target indicators. Results and discussion. The minimum required values of VO2 peak to provide an active daily life equals on average 15 -18 ml/min *kg of oxygen. Analysis of the results of our study showed a decrease in the VO2 peak in group 1 of stroke patients to 13.22 ± 3.32 ml/min * kg. The VO2 peak at stroke is only 54.96% ± 12.82 of the proper average values of VO2 and corresponds to 3.73 ± 0.92 MET. The results of the study confirm a very low level of exercise tolerance in the stroke group, which is significantly lower than in the CCI group (VO2 peak is 19.43 ± 4.77 ml/min * kg, which is 83.96 ± 12.93% of the proper average values and corresponds to 5.74 ± 1 .65 MET). The results of the study confirm a very low level of exercise tolerance in the stroke group, which is significantly lower than in the CCI group (VO2 peak is 19.43 ± 4.77 ml/min * kg, which is 83.96 ± 12.93% of the proper average values and corresponds to 5.74 ± 1.65 MET). Cardiopulmonary testing showed the absence of reliable dynamics of VO2 peak (p=0.29) and MET (p= 0.4) at the end of the rehabilitation course. A significant increase in VO2 peak was observed only in some patients who reached a load intensity level of 70% or more of the peak heart rate during training. Later a control study was conducted among 16 patients of the stoke group after 6 months. Cardiopulmonary testing showed the absence of reliable dynamics of the studied parameters in the absence of cardio training ambulatory. Our study of the patients’ with stroke condition in dynamics showed that there was no possibility of spontaneous (without aerobic exercise) restoration of exercise tolerance. Conclusion. In the early recovery period of IS, patients have a persistent long-term decrease of overall tolerance. Aerobic exercises have shown safety and good tolerance in IS rehabilitation programs. Aerobic exercises should be long-term, begin in a hospital and continue during ambulatory treatment. The intensity of training is a key parameter in the adjustment of Aerobic exercises for the patients with IS.

Comparison of the efficacy of Cellex and Cortexin in patients in the early recovery period of ischemic stroke

To compare the efficacy of Cellex and Cortexin in patients in the early recovery period of ischemic stroke (ERPIS) receiving basic therapy (BT). Forty patients were randomized into the cellex group (n=20) and the cortexin group 2 (n=20). Cellex was administered in a dose of 0.1 mg daily SC for 10 days and cortexin in a dose of 10 mg per 2 ml of 0.9% NaCl solution IM daily for 10 days. The efficacy of treatment was assessed with NIHSS, Bartel's index (BI), MMSE, the Rivermead Mobility Index (RMI), the Frontal Assessment Battery (FAB), Beck's depression scale (BDS). A more pronounced positive dynamics of NIHSS: 3 [2; 4.5] vs. 5 [2; 7] (p=0.03) and MMSE scores: 24 [21.5; 25] vs. 22 [20; 23] (p=0.04) was noted in the cellex group. Also, in this group, a more significant trend towards regression of depressive disorders (BDS) was revealed: 17.5 [14.5; 21] vs. 14 [13; 16] (p=0.064). The dynamics of RMI and FAB scores did not differ significantly between the groups. The use of cellex in comparison with cortexin is more effective in terms of the dynamics of regression of neurological and neurocognitive dysfunctions in patients with ERPIS.

Robotic recovery of walking function in patients in the early recovery period of stroke

To compare the efficacy of walking function recovery in patients in the early recovery period of ischemic stroke (IS) using an exoskeleton for the lower extremities and an active-passive pedal exercise bike. An open randomized study of 47 patients in the early recovery period of IS was conducted. The rehabilitation course included exercises on an ExoAtlet exoskeleton in group 1 and exercises on a pedal simulator for active-passive training (5 days a week for 2 weeks) in group 2. Several tests were used to evaluate treatment results, including the Hauser walking index, the 10-meter walking test, the Berg balance scale, stabilometry, and biomechanics of walking. The complete training course was completed by 20 patients of group 1 and 21 of group 2. There was a significant increase in strength in paretic muscles, postural stability, functional level and walking speed in patients of both groups, but in patients of group 1, the dynamics of recovery was more pronounced (p<0.05). In group 1, there was a significant decrease in the level of disability and an increase in daily activity, which was higher compared to group 2. An analysis of the main indicators of the statokinesiogram showed the more pronounced positive shifts in patients of group 1, but significant differences were found only in the dynamics of the length and area of the curve in the test with eyes open. When studying the biomechanics of walking, it was found that the function of walking was changed: there was a significant decrease in the speed of movement by 2.2 times, the length of a double step by 1.6 times, and the pace of walking by 1.3 times compared to normal indicators. After the end of exercises, a significant increase in the length of the double step, speed and pace of walking as well as a decrease in the period of the locomotor cycle were found in group 1. The study revealed a positive impact of hardware rehabilitation on locomotion, both with the use of an exoskeleton and an active-passive pedal simulator. The use of an exoskeleton, have the advantages resulting in a significantly greater recovery of strength, stability, speed and symmetry of walking over the same period of training. A significant increase in postural stability in vertical position was revealed.

Restoration of Speech Functions in Patients with Aphasia in the Early Rehabilitation Period of Ischemic Stroke

Objectives. To study the efficacy of complex therapy including daily speech therapy and two courses of Cellex in patients with aphasia in the early recovery period of ischemic stroke (IS). Materials and methods. Forty patients in the early recovery period of IS in the basin of the left middle cerebral artery with moderate or severe aphasia were studied. Twenty patients received complex therapy, including daily sessions with a speech therapist/aphasia specialist for 10 days using an improved method followed by self-study using educational materials and two 10-day courses of Cellex injections; the other 20 patients received only speech therapy. Treatment efficacy was evaluated using an automatic “Aphasia patient study program,” the Goodglass–Kaplan scale, and the modified Rankin scale. Results and conclusions. Patients of both groups achieved significant improvements in speech functions, communicative abilities, and functional recovery (p < 0.01); patients receiving complex therapy including two courses of Cellex injections showed significantly higher levels of rehabilitation (p < 0.05). These results allow the inclusion of Cellex into the complex restorative treatment of patients with poststroke speech impairments to be recommended.