Rehabilitation Of Neurological Patients Research Articles

Application of augmented reality in physical rehabilitation

Augmented reality (AR) has become a popular multidisciplinary research field in recent decades. Augmented reality adds to the subject's real-world sensory information through computer-generated sound, text, and graphics that are projected into the user's natural visual and auditory fields to provide a real-time interactive experience in a common environment. A bibliographic review was carried out with the objective of updating the current state of the use of augmented reality in physical rehabilitation. Augmented reality systems consist of a user interface that offers a motivational component to patients to perform exercises, distracting them from the potential pain they may feel during exercises. Additionally, they can be implemented in the patient's home and eliminate frequent visits to rehabilitation clinics. Among the most used systems are ARS, RehaBio, NeuroR, AR Fruit Ninja, MirrARbilitation, SleeveAR, ARIS and BRU. Its uses have been focused mainly on post-surgical orthopedic and neurological rehabilitation in patients with strokes. Augmented reality offers significant benefits over in-person rehabilitation and other technologies such as virtual reality, which can speed up the recovery process and improve patients' quality of life

Effect of Music Based Therapy Rhythmic Auditory Stimulation (RAS) Using Wearable Device in Rehabilitation of Neurological Patients: A Systematic Review.

(1) Background: Even though music therapy is acknowledged to have positive benefits in neurology, there is still a lack of knowledge in the literature about the applicability of music treatments in clinical practice with a neurological population using wearable devices. (2) Methods: a systematic review was conducted following PRISMA 2020 guidelines on the 29 October 2022, searching in five databases: PubMed, PEDro, Medline, Web of Science, and Science Direct. (3) Results: A total of 2964 articles were found, including 413 from PubMed, 248 from Web of Science, 2110 from Science Direct, 163 from Medline, and none from PEDro. Duplicate entries, of which there were 1262, were eliminated. In the first screening phase, 1702 papers were screened for title and abstract. Subsequently, 1667 papers were removed, based on population, duplicate, outcome, and poor study design. Only 15 studies were considered after 35 papers had their full texts verified. Results showed significant values of spatiotemporal gait parameters in music-based therapy rhythmic auditory stimulation (RAS), including speed, stride length, cadence, and ROM. (4) Conclusions: The current findings confirm the value of music-based therapy RAS as a favorable and effective tool to implement in the health care system for the rehabilitation of patients with movement disorders.

High-Intensity Interval Training v/s Steady-State Cardio in Rehabilitation of Neurological Patients

High-Intensity Interval Training v/s Steady-State Cardio in Rehabilitation of Neurological Patients

Comparative assessment of blood gas composition in children with cerebral ischemia during single and course application of physical factors

Introduction (relevance): Cerebral ischemia (CI) is damage to the brain tissue resulting from prolonged insufficient oxygen supply. CI occupies one of the leading places in the structure of morbidity in terms of frequency and significance, accounting for up to 60-80% of all diseases of early childhood and ranking first in the structure of childhood disability. Currently, an active search and development of new, pathogenetically substantiated, non-drug methods of treatment is underway. The purpose of the study: to study the effect of general magnetic therapy and hyperbaric oxygen therapy on the blood gas composition in children with cerebral ischemia against the background of a single and course application of physical factors. Material and methods: The results of treatment of 150 children in the first month of life with cerebral ischemia of moderate severity and intracranial hypertension syndrome, who underwent the inpatient stage, were analyzed. Depending on the treatment complex used, the children were divided into three statistically homogeneous groups of 50 people each. The patients of the main groups received physiotherapy treatment along with the standard complex. The patients of the main group I were prescribed general magnetic therapy (GMT) along with the standard complex. The patients of the main group II received basic therapy for this pathology and consecutive courses of general magnetic therapy and hyperbaric oxygen therapy (HBOT). In the course of the work, the acid-base status of capillary blood was studied. The analysis of the study results and the construction of tables and charts were carried out using the Microsoft Office 2010 office suite, the Statistica 6.0 statistical software package, and evidence-based medicine methods. Results: A comparative analysis of a single effect of various therapeutic methods on impaired acid-base balance indicators revealed a significant advantage of hyperbaric oxygen therapy in eliminating the phenomena of metabolic acidosis. The results obtained during the course administration of physical factors reliably prove the absence of a relationship between the elimination of the phenomena of metabolic acidosis, which aggravates the post-hypoxic recovery of the child's brain tissue, and the chosen therapeutic tactics for the course CI treatment, having an equivalent effect on the neurological rehabilitation of patients. Conclusion: The therapeutic effect of general magnetic therapy and its complex with hyperbaric oxygen therapy became a trigger factor for the activation of tissue respiration and cellular metabolism and led to a significant elimination of metabolic acidosis in most patients. The leading position as a catalyst for the metabolic and respiratory processes of the cell is occupied by hyperbaric oxygen therapy, which contributes to the normalization of the acid-base status of the blood in children with CI even after a single application, compared to basic therapy and general magnetic therapy.

Biomarkers for rhythmic and discrete dynamic primitives in locomotion

Rehabilitation can promote brain plasticity and improve motor control after central nervous system injuries. Our working model is that motor control is encoded using dynamic primitives: submovements, oscillations, and mechanical impedances. We hypothesize that therapies focusing on these primitives can achieve greater motor recovery. At the observational level, these primitives lead to discrete and rhythmic movements. Here, we propose two novel biomarkers to evaluate rhythmic and discrete movements in gait based on the feet forward position: the smoothness of their relative position, using the mean-squared jerk ratio (MSJR), to assess rhythmicity; and the angle between principal components of consecutive trajectories (dPCA), to detect discrete movements amidst rhythmic motion. We applied these methods to kinematic data collected with healthy individuals during experiments employing the MIT-Skywalker: level-ground walking at five speeds, with and without imposed ankle stiffness; walking at constant speed on ascending, descending, and laterally tilted slopes; and performing sidesteps. We found a decrease in MSJR as speed increases, related to increased rhythmicity, even with imposed stiffness. Rhythmicity seems unaffected by the terrain perturbations imposed. Finally, dPCA successfully detects sidesteps, discrete events amidst rhythmic movement. These biomarkers appear to accurately assess rhythmic and discrete movements during walking and can potentially improve clinical evaluation and rehabilitation of neurological patients.

Rhythmic auditory stimulation during gait adaptation enhances learning aftereffects and savings by reducing common neural drives to lower limb muscles.

Rhythmic auditory stimulation (RAS) improves gait symmetry in neurological patients with asymmetric gait patterns. However, whether RAS can accelerate gait adaptation remains unclear. This study aimed to investigate whether RAS during gait adaptation can enhance learning aftereffects and savings of gait symmetries. Furthermore, we investigated the differences in the coherence of paired surface electromyographic (EMG) recordings during gait adaptation between with and without RAS. Nineteen healthy young adults were subjected to continuous treadmill gait with swing phase perturbation (adaptation period) with or without RAS (RAS or no-RAS condition) for 5 or 10 min (short- or long-time condition), without the perturbation for 5 min (de-adaptation period), and with the perturbation for another 5 min (re-adaptation period). Swing phase and step length symmetries were significantly greater in the RAS conditions than in the no-RAS conditions during the adaptation period. Learning aftereffects and savings of gait symmetries were significantly greater in the RAS conditions than in the no-RAS conditions in the early de-adaptation and re-adaptation periods, respectively. There were no significant differences in savings in the early re-adaptation period between the short- and long-time conditions in the RAS condition. EMG-EMG coherence in the rectus femoris muscle in the β band (15-35 Hz) on the perturbed side was significantly lower during the early adaptation period in the RAS than in the no-RAS conditions. Therefore, RAS may enhance learning efficiency by reducing common neural drives from a cortical structure during gait adaptation, which could induce high savings of a learned gait pattern, even within short-time periods.NEW & NOTEWORTHY RAS during gait adaptation against swing phase perturbation enhances learning aftereffects and savings of gait symmetries. EMG-EMG coherence in the rectus femoris muscle in the β band on the perturbed side during the swing phase was significantly lower in the RAS than in the no-RAS conditions during the early adaptation period. These results support the application of RAS as external feedback to improve gait symmetry during gait adaptation in the rehabilitation of neurological patients.

Effect of staged acupuncture on serum irisin level and neurological rehabilitation in patients with ischemic stroke

To observe the effect of staged acupuncture on serum irisin level, neurological deficit, balance ability and spasticity in patients with ischemic stroke. Sixty patients with ischemic stroke were randomly divided into a staged acupuncture group and a routine acupuncture group, 30 cases in each group; another 30 healthy subjects were selected as a normal group. The patients with ischemic stroke were treated with aspirin (100 mg each time, once a day, changing to 50 mg for prophylactic dose after 4 weeks). The patients in the staged acupuncture group were treated with staged acupuncture (acupoints were selected according to the soft paralysis period, spasticity period and recovery period, sequelae period) and rehabilitation treatment, while the patients in the routine acupuncture group were treated with acupuncture of soft paralysis-period as the staged acupuncture group and rehabilitation treatment. All the treatment was given once a day, 5 times a week, 2 weeks as a course of treatment, and 4 consecutive courses of treatment were provided. Before treatment and at 2 weeks, 4 weeks, 6 weeks and 8 weeks into treatment, the serum irisin level was measured, and the scores of National Institutes of Health stroke scale (NIHSS), Fugl-Meyer assessment scale-balance (FM-B) and comprehensive spasticity scale (CSS) were compared, and the correlation between the serum irisin level and NIHSS and FM-B scores in the two groups was analyzed. Before treatment, the serum irisin levels in the two groups were lower than those in the normal group (P<0.01). Compared before treatment, the serum irisin levels and FM-B scores were increased (P<0.01), and the NIHSS scores were decreased at 2, 4, 6 and 8 weeks into treatment in the two groups (P<0.01). At 4, 6 and 8 weeks into treatment, in the staged acupuncture group, the serum irisin levels and FM-B scores were higher than those in the routine acupuncture group (P<0.01, P<0.05), and the NIHSS scores were lower than those in the routine acupuncture group (P<0.01). After treatment, the CSS scores in the two groups were increased first and then decreased. Compared before treatment, the CSS scores were increased at 2, 4, 6 and 8 weeks into treatment in the two groups (P<0.01). At 4, 6 and 8 weeks into treatment, the CSS scores in the staged acupuncture group were lower than those in the routine acupuncture group (P<0.01). The serum irisin level was negatively correlated with NIHSS score (r =-0.772, P =0.000), and positively correlated with FM-B score (r =0.675, P =0.000). The severity of neurological deficit and balance ability are related to serum irisin level in patients with ischemic stroke. The staged acupuncture could increase the serum irisin level, improve the neurological function, balance ability and spasticity in patients with ischemic stroke.

An evidence-based evaluation of Buyang Huanwu decoction for the treatment of the sequelae of stroke: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials

BackgroundBuyang Huanwu decoction (BYHWD) is a famous traditional Chinese formula that has been widely prescribed for sequelae of stroke in China. However, the efficacy and safety of BYHWD in treating sequelae of stroke have never been systematically evaluated. PurposeTo evaluate the effectiveness and safety of BYHWD in the treatment of sequelae of stroke. Study designA Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review and meta-analysis of randomized clinical trials (RCTs). Materials and methodsA systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Five common electronic databases were searched for relevant RCTs from their inception until May 20, 2022. The Cochrane risk-of-bias tool was used to evaluate the methodological quality and the risk of bias of the included RCTs. Review Manager 5.4 was used to analyse all the data obtained. The clinical effective rate (CER) was the primary outcome, and National Institutes of Health Stroke Scale (NIHSS) and Fugl-Meyer Assessment (FMA) scores were the secondary outcomes. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate the quality of evidence for each outcome. ResultsThirty-two clinical studies that recruited 2,527 eligible patients were included in this meta-analysis. The results of the meta-analysis suggested that compared with conventional treatment alone, the addition of BYHWD significantly improved the CER (RR = 1.24, 95% CI: 1.20-1.29, p < 0.00001), decreased the NIHSS score (MD = -5.42, 95% CI: -5.87-4.97, p < 0.00001), and increased the FMA score (MD = 17.28, 95% CI: 15.12-19.45, p < 0.00001). There were no reported adverse events in the included studies. Most results were robust, and the quality of evidence was moderate. ConclusionOur study is the first meta-analysis of RCTs evaluating the effects of BYHWD on sequelae of stroke. The addition of BYHWD to conventional treatment for sequelae of stroke significantly improved the CER and promoted neurological rehabilitation in patients, and there were no reported adverse events associated with this combination therapy. The findings of our study support the use of BYHWD as an adjunct treatment to conventional treatment in this clinical population. However, due to the limitations of the included clinical trials, high-quality clinical trials with longer follow-ups are needed to assess the long-term effectiveness and safety of BYHWD for treating the sequelae of stroke.

Шкалы и тесты для оценки эффективности телереабилитации пациентов, перенесших инсульт

This article provides international scales and tests used in the telerehabilitation of stroke patients. The practical value of the work lies in the fact that, based on the analysis of international scientific articles published on the basis of randomized clinical trials, scales and tests used in telerehabilitation are given. The results of this study can be used by healthcare professionals, doctors and medical workers to organize telerehabilitation ofpost-stroke patients under Russian conditions, as well as in clinical trials. The article may be useful to scientific and academic staff, resident doctors and other specialists who are dealing with digital rehabilitation of neurological patients or conducting research.

Magnetic Resonance Image Feature Analysis under Deep Learning in Diagnosis of Neurological Rehabilitation in Patients with Cerebrovascular Diseases.

To explore the impact of magnetic resonance imaging (MRI) image features based on deep learning algorithms on the neurological rehabilitation of patients with cerebrovascular diseases, eighty patients with acute cerebrovascular disease were selected as the research objects. According to whether the patients were with vascular cognitive impairment (VCI), they were divided into VCI group (34 cases) and non-VCI group (46 cases). In addition, based on the convolutional neural network (CNN), a new multimodal CNN image segmentation algorithm was proposed. The algorithm was applied to the segmentation of MRI images of patients with vascular cognitive impairment (VCI) and compared with the segmentation results of CNN and fully CNN (FCN). As a result, the segmentation results of the three different algorithms showed that the Dice coefficient, accuracy, and recall of the multimodal CNN algorithm were 0.78 ± 0.24, 0.81 ± 0.28, and 0.88 ± 0.32, respectively, which were significantly increased compared to those of other two algorithms (P < 0.05). The neurological evaluation results showed that the MMSE and MoCA scores of VCI patients were 15.4 and 14.6 ± 5.31, respectively, which were significantly lower than those of the non-VCI group (P < 0.05). The TMT-a and TMT-b scores of VCI patients were 221.7 and 385.9, respectively, which were significantly higher than those of the non-VCI group (P < 0.05). The FA and MD values of nerve function-related fibers shown in the MRI images of the VCI group were significantly different from those of the non-VCI group (P < 0.05). Therefore, the neurological recovery process of VCI patients was affected by multiple neurocognitive-related fiber structures. To sum up, the multimodal CNN algorithm can sensitively and accurately reflect the degree of neurological impairment in patients with cerebrovascular disease and can be applied to disease diagnosis and neurological evaluation of VCI patients.

Assessment of the functional state of the brain by neuroenergy mapping as a way to optimize neurological rehabilitation

Neurological rehabilitation of patients with brain injuries is a complex interdisciplinary system aimed at restoring and producing compensatory mechanisms, as well as psychological and social readaptation of patients. An important issue is a personalized rehabilitation program for each individual patient. One method that can help solve this problem is neuroenergy mapping.

Fallvignetten aus der neurologischen Rehabilitation bei Patienten mit Post-COVID-Syndrom

Case vignettes from neurological rehabilitation in patients with post-COVID syndrome – Suggested discussion for performance diagnosticsC. Dettmers, C. Weich, C. Herrmann, R. Saile, M. Preuss, S. H. Chanyalew, L. Schleicher, D. Klaasen van Husen, J. Randerath, S. Stoll, M. Tempfli, M. Vieten, M. JöbgesAbstractSecondary illness after a previous infection with SARS-CoV-2 covers a wide spectrum in terms of organ damage, symptoms, duration, course and, above all, the severity of the disease. In patients who have been ventilated for a long time in an intensive care unit, one will look very carefully for lung damage and other organ damage, including cerebral, peripheral neurogenic and myogenic damage, and clarify to what extent the remaining deficits can be attributed to this. At the other end of the spectrum are patients who were not hospitalized during the primary infection, for whom fatigue, headache, muscle, limb or other symptoms are in the foreground and whose symptoms often fluctuate in intensity over the course of the disease. For employees in the health sector, a primary infection acquired at work may be recognized as an occupational disease. Subsequent complaints are often subsumed under “post-COVID” by the patient and then also by the attending physician, without proving a causal connection to COVID-19. We present individual case studies from this specific and non-representative group. We were surprised that there were many psy-chological, psychosomatic and psychiatric comorbidities. In the second part we present our diagnostics for cognitive, emotional and motor fatigue and fati-gability. Particularly in this initially non-hospitalized patient group, a thorough somato-psychological differential diagnosis is required in order to determine the causes and the socio-psychosomatic set of conditions. An identification of the different components within the post-COVID complaint complex should enable the most efficient therapy possible in order to initiate reintegration into social life in everyday life and at work. Keywords: Post-COVID syndrome, comorbidity, psychosomatics, fatigue, fatigability, differential diagnostics

Fuzzy Clustering Algorithm-Segmented MRI Images in Analysis of Effects of Mental Imagery on Neurorehabilitation of Stroke Patients

The study focused on the automatic segmentation of Magnetic Resonance Imaging (MRI) images of stroke patients and the therapeutic effects of Mental Imagery on motor and neurological functions after stroke. First, the traditional fuzzy c-means (FCM) algorithm was optimized, and the optimized one was defined as filter-based FCM (FBFCM). 62 stroke patients were selected as the research subjects and randomly divided into the experimental group and the control group. The control group accepted the conventional rehabilitation training, and the experimental group accepted Mental Imagery on the basis of the control group. They all had the MRI examination, and their brain MRI images were segmented by the FBFCM algorithm. The MRI images before and after treatment were analyzed to evaluate the therapeutic effects of Mental Imagery on patients with motor and nerve dysfunction after stroke. The results showed that the segmentation coefficient of the FBFCM algorithm was 0.9315 and the segmentation entropy was 0.1098, which were significantly different from those of the traditional fuzzy c-means (FCM) algorithm. ( P &lt; 0.05 ), suggesting that the FBFCM algorithm had good segmentation effects on brain MRI images of stroke patients. After Mental Imagery, it was found that the patient’s Function Independent Measure (FIM) score was 99.04 ± 8.19, the Modified Barthel Index (MBI) score was 51.29 ± 4.35, the Fugl-Meyer (FMA) score was 61.01 ± 4.16, the neurological deficit degree in stroke (NFDS) score was 11.48 ± 2.01, the NIH Stroke Scale (NIHSS) score was 10.36 ± 1.69, and the clinical effective rate was 87.1%, all significantly different from those of the conventional rehabilitation training group ( P &lt; 0.05 ). Additionally, the brain area activated by Mental Imagery was more extensive. In conclusion, the FBFCM algorithm demonstrates superb capabilities in segmenting MRI images of stroke patients and is worth promotion in clinic. Mental Imagery can promote the neurological rehabilitation of patients by activating relevant brain areas of patients.

Influence of Whole-course Detail Nursing Intervention on Neurological Rehabilitation of Patients with Osteoarthritis after Surgery

Influence of Whole-course Detail Nursing Intervention on Neurological Rehabilitation of Patients with Osteoarthritis after Surgery

Гемостаз и когнитивный мозг: 5П-медицина и хронотерапия артериальной гипертонии

Neurophysiological and cardioneurological polyfunctional studies of the brain-heart system in the rehabilitation of neurological patients using high medical technologies will help answer many questions related to the optimization of patient management in combined cerebral and cardiac pathology in the recovery period. Late chronotype and later sleep patterns are associated with greater morbidity, including higher rates of metabolic dysfunction and cardiovascular disease (CVD). Numerous studies have been adjusted for age, sex, ethnicity, smoking, body mass index, sleep duration, socioeconomic status, and comorbidities. Age groups, especially being a defined evening type, were significantly associated with a higher prevalence of all comorbidities. The results suggest increased mortality in evening types and increased levels of cardiometabolic risk factors in these groups. The risk of mortality in evening types may be due to behavioral, psychological, and physiological risk factors, many of which may be associated with chronic inconsistencies between internal physiological timelines and external working and social activities. Multilevel and interneural interactions are a leading factor in the formation of higher mental functions and self-development of the personality. Circadian homeostasis regulates and synchronizes the functions of adult stem cells and their changes during aging, as well as modulates their external and internal mechanisms. The circadian clock synchronizes cellular physiology with daily environmental changes and can both positively and negatively affect physiological processes. Circadian onset of CVD often shows a change in the time of day and is associated with the molecular clock system. Acute myocardial infarction or ventricular arrhythmia (ventricular tachycardia) occurs mainly early in the morning. Numerous biochemical and physiological parameters show a circadian rhythm that may explain daily variations in cardiovascular events. These include fluctuations in blood pressure, autonomic nervous system and renin-angiotensin axis activity, blood clotting cascade, vascular tone and intracellular metabolism of cardiomyocytes. New insights into the molecular and cellular pathways by which cardiovascular events occur in a daily oscillatory pattern will help create a new therapeutic approach to CVD treatment. Research continues on the updated modern problem of circadian brain and heart neurocommunications during the period of electromagnetic and information load/overload, the influence of new genetics and epigenetics, changes in hemostasis and homeostasis, the formation of new immunity and microbiota, in conjunction with modern neurobite and neuromarketing, with 5P Medicine and 5G technologies of neurocommunication.

Music Therapy: A Modalities to Consider During Rehabilitation of Neurological Patients

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Is Virtual Reality Effective for Balance Recovery in Patients with Spinal Cord Injury? A Systematic Review and Meta-Analysis.

Virtual reality (VR) is an emerging tool used in the neurological rehabilitation of patients with spinal cord injury (SCI), focused on recovering balance, mobility, and motor function, among other functional outcomes. The main objective of this study was to analyze the effectiveness of VR systems to recover balance in patients with SCI. The literature search was performed between October and December 2019 in the following databases: Embase, Web of Science, CINAHL, Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and the Cochrane Central Register of Controlled Trials. The methodological quality of each study was assessed using the Spinal Cord Injury Rehabilitation Evidence (SCIRE) system and the PEDro scale, while the risk of bias was analyzed by the Cochrane Collaboration’s tool. A total of 12 studies, involving 188 participants, were included in the systematic review, of which two were included in the meta-analysis. Statistical analysis showed favorable results for balance measured by the modified Functional Reach Test (standardized mean difference (SMD) = 3.42; 95% confidence interval: 2.54 to 4.29) and by the t-shirt test (SMD= −2.29; 95% confidence interval: −3.00 to −1.59). The results showed that VR interventions provided potential benefits, in addition to conventional physical therapy, to recover balance in patients with SCI.

Application of Stem Cells in Stroke: A Multifactorial Approach.

Stroke has a debilitating effect on the human body and a serious negative effect on society, with a global incidence of one in every six people. According to the World Health Organization, 15 million people suffer stroke worldwide each year. Of these, 5 million die and another 5 million are permanently disabled. Motor and cognitive deficits like hemiparesis, paralysis, chronic pain, and psychomotor and behavioral symptoms can persist long term and prevent the patient from fully reintegrating into society, therefore continuing to add to the costly healthcare burden of stroke. Regenerative medicine using stem cells seems to be a panacea for sequelae after stroke. Stem cell-based therapy aids neuro-regeneration and neuroprotection for neurological recovery in patients. However, the use of stem cells as a therapy in stroke patients still needs a lot of research at both basic and translational levels. As well as the mode of action of stem cells in reversing the symptoms not being clear, there are several clinical parameters that need to be addressed before establishing stem cell therapy in stroke, such as the type of stem cells to be administered, the number of stem cells, the timing of dosage, whether dose-boosters are required, the route of administration, etc. There are upcoming prospects of cell-free therapy also by using exosomes derived from stem cells. There are several ongoing pre-clinical studies aiming to answer these questions. Despite still being in the development stage, stem cell therapy holds great potential for neurological rehabilitation in patients suffering from stroke.

АНАЛИЗ И КЛАССИФИКАЦИЯ РЕАБИЛИТАЦИОННЫХ РОБОТОТЕХНИЧЕСКИХ СИСТЕМ НА БАЗЕ ПАРАЛЛЕЛЬНЫХ МАНИПУЛЯТОРОВ

One of the most actual and complex problems of medicine and neurology is the rehabilitation of patients. Robotic systems currently occupy an important place in the comprehensive rehabilitation of neurological patients with severe motor impairment of various etiologies, as well as the most socially significant and common neurological diseases. The article discusses various architectures of robotic systems for the rehabilitation of the lower limbs. The article also analyzes the work of foreign scientists who deal with these issues. As a result, a classification of rehabilitation systems has been compiled and reviewed. The structure of the rehabilitation system based on a passive orthosis and active parallel 3-PRRR robot is proposed. A numerical algorithm has been developed to determine the workspace of a 3-PRRR robot, taking into account design limitations. The algorithm is based on the concept of non-uniform coverings using interval analysis methods and is implemented in the C++ programming language. The results of computational experiments are presented. The simulation results are visualized by converting a set of three-dimensional parallelepipeds into an STL file. However, many areas remain open to theoretical research. A further area of research is the optimization of the geometric parameters of the system for carrying out rehabilitation procedures.

Willed‑movement training reduces middle cerebral artery occlusion‑induced motor deficits and improves angiogenesis and survival of cerebral endothelial cells via upregulating hypoxia‑inducible factor‑1α.

Willed movement facilitates neurological rehabilitation in patients with stroke. Focal ischaemia is the hallmark of patients after stroke, though the detailed molecular mechanism by which willed movement affects neurological rehabilitation after stroke is not fully understood. The aim of the present study was to dissect the key factors of the hypoxia signaling pathway responsible for the willed movement‑improved rehabilitation. Sprague‑Dawley rats undergoing right middle cerebral artery occlusion (MCAO) surgery were randomly divided into four groups: MCAO alone, willed movement (WM), environmental modification (EM) and common rehabilitation (CR). The neurological behaviour score was assessed, and infarction areas were detected by TTC staining. In addition, angiogenesis‑associated genes (vascular epithelial growth factor, angiogenin‑1, matrix metalloproteinases‑2 and ‑9) and hypoxia inducible factor (HIF)‑1α expression was investigated in cells derived from MCAO, WM, EM and CR groups. Finally, the role of HIF‑1α using HIF‑1α knockdown in HUVECs under hypoxic conditions was evaluated. WM significantly improved neurological behaviour and rehabilitation by increasing the behaviour score and by decreasing the infarction area. In addition, CR, EM and WM raised the expression of angiogenesis‑associated genes and HIF‑1α, thereby promoting invitro tube formation of primary endothelial cells. Knockdown of HIF‑1α in HUVECs restored the increased expression of angiogenesis‑associated genes to normal levels and inhibited invitro tube formation of HUVECs. Willed movement most effectively improved the neurological rehabilitation of rats with focal ischaemia through upregulation of HIF‑1α. The present findings provide insight into willed movement‑facilitated rehabilitation and may help treat stroke‑triggered motor deficit and improve angiogenesis of cerebral endothelial cells.