[Medical rehabilitation of gait disorders in multiple sclerosis]. / Meditsinskaya reabilitatsiya pri narusheniyakh khod'by u bol'nykh rasseyannym sklerozom.

The most common and important consequence of multiple sclerosis (MS) is impaired walking, which limits daily activities and increases the risk of falling. This article provides an overview of the main non-pharmacological methods of medical rehabilitation of gait disorders in people with MS (aerobic and strength training, robotic technologies, orthotics and functional electrical stimulation), which have an evidence base on systematic reviews and meta-analyses. Special attention is paid to the approach to rehabilitation in people with severe disabilities. Methods for determining gait parameters using tests and high-tech devices are considered, which serve as the basis for the routine assessment of the domains of the International Classification of Functioning (ICF) and the effectiveness of interventions.

[Kinematic parameters of gait in patients with supra- or subtentorial focus location during the early rehabilitation period after ischemic stroke]. / Kinematicheskie parametry pokhodki pri supra- i subtentorial'noi lokalizatsii ochaga v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

OBJECTIVE: To study kinematic gait parameters during early rehabilitation period in patients with supra- or subtentorial ischemic stroke (IS). MATERIAL AND METHODS: We examined 24 patients (11 women, 13 men, age 61.3±8.2) 4-6 weeks after stroke onset. 15 patients had supratentorial IS (middle cerebral artery location), 9 patients had subtentorial IS (brainstem and cerebellum). NIHSS score was 6.4±0.6/6.1±0.8, modified Ashwort scale score - 0.5±0.6/0.4±0.7, hand paresis - 3.4±0.9/3.7±0.7, leg paresis - 4.1±0.7/4.0±0.8 points. Kinematic gait parameters were recorded on video analysis system Physiomed Smart (Physiomed, Germany, Davis protocol). RESULTS: Gait kinematic parameters in paretic and in unaffected leg were changed in both groups. Patients with supratentorial lesion had on paretic side exaggerated pelvic obliquity, an excessive internal rotation and amplitude of movements in the paretic hip joint, and an insufficient plantar extension on both sides. Patients with subtentorial stroke had exaggerated pelvic tilt forward, excessive flexion and insufficient extension of the hip joint, insufficient extension of the knee joint, excessive plantar flexion, and insufficient plantar extension on both sides. CONCLUSION: Patients with supra- or subtentorial IS with muscle weakness less than 3-4 points and slightly changed or normal muscle tone differed in kinematic parameters in pelvic motions and in joints of paretic and unaffected lower extremity. These results highlight the importance of differentiating rehabilitation techniques according to supra- or subtentorial focus location and cerebellar involvement.

[A relationship between the movement pattern and lesion location in the early rehabilitation period after ischemic stroke]. / Sviaz' dvigatel'nogo stereotipa i lokalizatsii ochaga v rannem vosstanovitel'nom periode legkogo ishemicheskogo insul'ta.

To study the changes in movement pattern during the early rehabilitation period in patients after carotid/vertebro-basilar ischemic stroke. MATERIAL AND METHODS: The authors studied 11 patients (6 women, 5 men, mean age 57.2±5.2) 4-6 weeks after stroke onset. NIHSS on admission was 6.2±0.8, arm/hand weakness 3.9±0.7/3.7±0.8, leg/foot weakness 4.3±0.6/4.0±0.5. The lesion was located in the carotid artery (7 patients) and in the vertebro-basilar system (4 patients). All patients were examined on admission and at discharge (interval 13±4 days). The changes were assessed using FIM scale, Ashwort scale, TUG test, nine-hole peg test (NHPT), Berg balance scale, 20-point vestibular disorder score scale, MMSE, Beck depression inventory, and Spielberger anxiety questionnaire. Also kinematic and kinetic profiles of the step cycle and gait were analyzed by video analysis system Physiomed Smart (Physiomed, Germany, Davis protocol). RESULTS: All patients demonstrated improvement in FIM scale, Ashwort scale, TUG test, NHP test, Berg balance scale and 20-point vestibular disorder score scale. Patients with vertebro-basilar stroke had balance disturbance, which was assessed with 20-point vestibular disorder score scale. All patients had changes in spatiotemporal gait performance, kinematic and kinetic profiles of the walking cycle: shortening of the step length and widening of the step width, prolongation of step cycle, and decreased step speed. These changes were more obvious in patients with vertebro-basilar stroke. Also patients with vertebro-basilar stroke had pelvic tilt forward, while patients with carotid lesion had pelvic obliquity. CONCLUSION: Lesion location in patients with mild stroke may influence the spatiotemporal gait characteristics and kinematic and kinetic profiles. These features should be taken into account while planning rehabilitation strategy.