Vol 6, No 1 (2024)
ORIGINAL STUDY ARTICLE
Personalized approach to assessing the functional result of acute ischemic stroke
Abstract
BACKGROUND: The main reason for the poor prognostic outcome in stroke patients is the polymorphism of cognitive and motor impairments.
AIM: The purpose of this study is to evaluate the impact of clinical and paraclinical factors on the functional outcome of the patient in the acute period of ischemic stroke based on statistical methodology.
MATERIALS AND METHODS: 160 patients of the primary vascular center with a diagnosis of “Ischemic stroke” were examined. Functional outcome parameters were designated as absolute values and were calculated as the difference between Montreal Cognitive Assessment (MoCA), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Modified Rankin (mRS) scale scores before and after treatment. The following criteria were considered as factors influencing the prognosis of the functional result of acute stroke: demographic characteristics, parameters of cognitive function, stroke characteristics (localization, lateralization, subtype). Mathematical statistics was performed using the Python programming language and the Pandas and SciPy libraries.
RESULTS: The mathematical model developed in this study made it possible to identify the main neuropsychological and clinical indicators that negatively and positively affect the functional result of acute stroke. As the main factors influencing the functional result in relation to MoCA, impairments in the areas of attention, speech and executive function, age, indicators on the IQCODE and ASPECTS scales were identified. Apraxia, agnosia, executive dysfunction, sex, age, lesion side, IQCODE parameters influenced the prognosis of the degree of patient’s daily activity according to IB. Regression of neurological symptoms according to NIHSS depended on indicators in the field of perception, praxis, speech, IQCODE and ASPECTS values. Semantic aphasia, mnestic and executive dysfunction, apraxia, and IQCODE scores were important for the prognosis of disability degree according to mRS.
CONCLUSION: The use of discriminant analysis to predict the functional result will allow to create personalized diagnostic and therapeutic strategies for managing patients in the acute period of ischemic stroke. The predictive value of clinical and paraclinical markers in relation to the recovery of motor and cognitive function of patients may be useful in the further management of ischemic stroke.
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Biofeedback training for the analysis of gait stereotypes in patients with gonarthrosis
Abstract
BACKGROUND: The justification of the treatment techniques for patients with gonarthrosis requires the use of modern methods for assessing walking stereotypes.
AIM: This study aimed to evaluate the biomechanical and podometric gait parameters of patients with gonarthrosis using the C-Mill multifunctional complex with biofeedback.
MATERIALS AND METHODS: The study included 55 patients who were divided into the following groups: main group (n=35) of patients who had gait disturbances, diagnosed with stage III–IV primary gonarthrosis with varus deformation of the limb axis according to ICD-10, and underwent total knee replacement and control group (n=20) of patients diagnosed with stage I primary gonarthrosis. The average age of patients was 58.7 years in the main group and 47.5 years in the control group.
RESULTS: In the main group, the decrease in average walking speed was accompanied by decreases in stride length and step frequency (р <0.05). In the stance phase, which is characterized by the contact of the foot of the affected and contralateral lower extremities with the platform surface, the durations of the double stance phase of both extremities in the main group were longer than those in the control group (p <0.05), indicating gait asymmetry and redistribution of excess load on the contralateral lower extremity, which is clinically manifested by lameness. In the main group, gait was characterized by a decrease in voluntary speed, step frequency, and gait pattern changes in various planes, confirming severe clinical and functional disorders in the lower limbs.
CONCLUSION: The study of the walking stereotype in patients using the C-Mill multifunctional complex with biofeedback can be used to substantiate treatment techniques, followed by drawing up an individual medical rehabilitation plan to restore lower limb functions in the postoperative period, fully monitor treatment dynamics, prevent falls, and improve the quality of life of patients.
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Consistency in the assessment of postural balance using static stabilometry and scale techniques in older individuals: An observational study
Abstract
BACKGROUND: In clinical practice, both clinical scales and instrumental methods are used in parallel to assess postural stability and the risk of falls. Literature data on the comparability of postural balance estimates obtained using scale techniques and stabilometry, particularly in older patients, are conflicting.
AIM: to analyze the consistency in the assessment of postural balance by static stabilometry and scale techniques in older patients.
MATERIALS AND METHODS: A pilot observational, nonrandomized, single-center study was conducted. The study participants were 39 women aged 60–75 years who did not have diseases or conditions that significantly affected the postural control system. Postural balance was assessed using clinical scales and tests (timed up and go test, classic and a double task; Berg balance scale; Mini-BESTest, balance evaluation systems test; performance-oriented mobility assessment; and falls efficacy scale) and basic spatial, spatiotemporal, and spectral parameters of static stabilometry. A stabilometric study was conducted at the posturological complex Biokinect. Correlation analysis of the data of the scale techniques and stabilometry was performed.
RESULTS: The correlation analysis showed both the correlation between some parameters of stabilogram and scale techniques and the complete absence of a significant correlation between others. However, even in the presence of a statistically significant correlation, the relationship between the parameters did not exceed the moderate or average level (maximum value of the correlation coefficient, 0.685, p <0.01). The largest correlation was found between the stabilometric parameters and the timed up and go test (correlated with 11 out of 21 parameters) and the falls efficacy scale (10 parameters), and the smallest was found with the Mini-BESTest (5 parameters). The values of the stabilometric parameter (speed of movement of the center of pressure) demonstrated a statistically significant correlation with most of the clinical instruments (4 out of 6).
CONCLUSION: This study showed low consistency between the basic parameters of static stabilometry and scale techniques in older people. The results of simpler scale techniques for the assessment of postural balance correlated better with stabilometry data than with more complex and multicomponent ones because the total indicator of the latter is a generalized assessment of postural stability and other elements of complex motor behavior associated with postural balance. Therefore, simple scale techniques and tasks should be preferred when assessing the basic postural stability and risk of falls in older people.
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REVIEWS
Ankle-foot orthosis in stroke survivors: status of the issue
Abstract
This paper presents an analysis of information regarding the peculiarity of ankle joint orthosis in cerebral stroke survivors. Gait research methods used to assess gait changes in patients who had suffered a cerebral stroke were briefly reviewed. The three most common patterns of gait impairment after a stroke, namely, stiff-knee gait, “dropped foot,” and gait with knee joint hyperextension, were described. A brief review of the main functional types of ankle joint orthoses, namely, static and dynamic, considering their strengths and weaknesses, was presented. Changes in temporal, spatial, and kinematic parameters of gait in cerebral stroke survivors using orthoses were reported. Changes in gait parameters when using ankle joint orthoses depending on the initial pattern of gait disturbance were assessed. The effect of orthotics on the angles of flexion in the ankle, knee, and hip joints at various gait phases as well as their effect on the speed, rhythm, and length of the step were described. Data on the effect of ankle orthosis on patient’s ability to maintain balance were also presented. The effects of orthosis on gait biomechanics and balance function in stroke survivors are debatable. Thus, our findings in this study allow us to raise the question regarding the optimal timing of the use of ankle joint orthoses during the recovery period of a stroke. Possible reasons for these ambiguous results were considered. The necessity for further research into the effectiveness of ankle–foot orthoses regarding various pathological gait patterns in stroke survivors is justified.
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Efferent methods of therapy for critical illness
Abstract
Extracorporeal blood purification is intended to eliminate dysregulation of the immune system. The concept of extracorporeal therapy is based on the nonspecific clearance of inflammatory mediators and triggers, which attenuates the systemic expression of inflammatory mediators. The main types of extracorporeal therapy are hemoadsorption and plasma exchange. Hemoadsorption is used primarily as an adjuvant treatment for septic shock and other severe inflammatory conditions, including severe forms of COVID-19 with cytokine storm.
Reliable data demonstrating the benefit of hemoadsorption in critically ill patientsis is limited. Recommendations for the use of hemoadsorption devices are often based on incomplete data or questionable interpretations of available data. Given the lack of evidence for the benefit of hemoadsorption in the treatment of severe inflammation, sepsis, liver failure and rhabdomyolysis, its routine use in clinical practice is not justified until the mechanisms underlying these findings are fully elucidated.
Plasma replacement is a potentially life-saving invasive extracorporeal blood purification procedure that replaces plasma with a substitute fluid (saline, albumin solution, fresh frozen plasma, or a combination of these) with the risk of side effects and complications. There is still uncertainty regarding the timing, type of plasma exchange, volume and frequency of plasma filtration. Although plasma replacement is considered to be relatively safe, there is still insufficient evidence to support its inclusion in sepsis treatment protocols.
Reports of the use of extracorporeal methods in the treatment of patients with severe refractory systemic inflammation provide evidence of decreased levels of inflammatory biomarkers, improved hemodynamic parameters, and decreased organ failure. However, according to the results of randomized clinical trials, extracorporeal therapy does not affect clinical outcomes, and in some even increases mortality. To clarify the effectiveness of extracorporeal therapy, it is necessary to study the mechanisms of interaction of the devices used with target and non-target blood components and large-scale randomized controlled trials assessing the ability of this therapy to improve clinical outcomes.
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CASE REPORT
Results of functional electrical stimulation of leg muscles during walking in a patient in the early recovery period after a stroke
Abstract
Acute cerebrovascular accident throughout the world remains the main cause of subsequent disability in persons who have suffered a stroke.
One promising area is neuromuscular stimulation. Functional electrical stimulation is a subtype of neuromuscular stimulation in which stimulation promotes functional and goal-oriented movements in the individual.
A course of functional electrical stimulation was administered while walking to a 74-year-old patient in the late recovery period of an ischemic stroke (the right middle cerebral artery). 14 procedures were performed lasting from 20 to 30 minutes. Before and after the functional electrical stimulation course, a clinical study and a study of the biomechanics of walking were conducted.
The results obtained showed an improvement in clinical indicators, inconsistent changes in the time parameters of the step cycle, an increase in amplitudes in the hip and knee joints, as well as normalization of the function of the knee and ankle joints of the paretic side. Functional EMG research showed both an improvement in muscle activity and normalization of their activity profile, as well as processes of function restructuring that require further study.
During functional electrical stimulation, there were no negative reactions from the patient or irritation of the skin at the locations of the electrodes.
The method of functional electrical stimulation requires further study and reasonable application in this category of patients.
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