[The effect of the start date of cognitive rehabilitation after ischemic stroke on the level of recovery]. / Vliyanie sroka nachala kognitivnoi reabilitatsii posle perenesennogo ishemicheskogo insul'ta na uroven' vosstanovleniya.

OBJECTIVE: The dependence of result of cognitive training in patients who have suffered an ischemic stroke (IS) on the timing of their onset continues to be discussed. The aim was to study the results of cognitive rehabilitation of patients after IS during various periods after it. MATERIAL AND METHODS: 140 patients were examined during complex rehabilitation in terms up to 1, 2-3, 4-6 and 7-12 months after IS, 78 of them received drug support (DS) of rehabilitation with intravenous injections of ampasse. The Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) were used to monitor the effectiveness of rehabilitation. RESULTS: In all subgroups, there was a statistically significant increase in the MoCA score after the course, but number of people with an increase in the score by 1 or more points was highest among those who started the course 3 or more months after the development of IS (p=0.015). Among those who received DS, an increase in the MoCA was noted in 87.2%, in those who did not receive it - 38.7% (p<0.001). There was no statistically significant increase in the severity of anxiety and depression after the course of treatment in any of the subgroups. CONCLUSION: The used approach of a combination of cognitive, physical rehabilitation and DS proved to be justified for achieving results during a two-week course of inpatient rehabilitation of patients both in the early and late recovery period after IS.

[Assessment of disorders of neurodynamic processes in patients with acute ischemic stroke]. / Otsenka narushenii neirodinamicheskikh protsessov u bol'nykh v ostrom periode ishemicheskogo insul'ta.

OBJECTIVE: To develop a method for assessing neurodynamic disorders in the acute period of stroke. MATERIAL AND METHODS: Sixty-three right-handed patients in the acute period of ischemic stroke (IS) were examined, including 28 patients with IS in the basin of the left middle cerebral artery (LMCA) (group 1), 19 patients with IS in the basin of the right middle cerebral artery (group 2) and 16 patients with IS in the vertebrobasilar system (group 3). The control group consisted of 37 healthy individuals. The «Tapping Test¼ technique developed by E.P. Ilyin was used to assess the strength of nervous processes. The mobility of nervous processes was determined by a complex sensorimotor reaction of discrimination. To assess the balance of the processes of excitation and inhibition, a complex sensorimotor reaction to a moving object was used. RESULTS: There was a significant decrease in the strength of nervous processes in the patients compared to the control group (p<0.0001), more pronounced in IS in LMCA. When checking the mobility of nervous processes in patients of groups 1 and 2, the number of errors was statistically significantly higher than in the control group (inertness of nervous processes). These indicators were the highest in patients with IS in LMCA while in patients of group 3 the lowest values, approaching the data of healthy individuals, were noted. When checking the balance of nervous processes, torpidity of reactions was noted in patients of group 1, torpidity when performing the test with a paretic hand was noted in group 2. In group 3 these indicators approach the data of healthy individuals, which reflected the approximate balance of the processes of excitation and inhibition. CONCLUSION: In the study of neurodynamic processes in patients in the acute period of IS, there was a decrease in strength, inertness, and torpidity of the mobility of nervous processes, more pronounced in the damage of the dominant hemisphere. It can be assumed that in the origin of these shifts in patients in the acute period of IS, a diaschisis plays an important role, and with left-sided localization of IS, not only the focal, but also its connective, transcallosal form.

[Possibilities of the brain-computer interface in the correction of post-stroke cognitive impairments]. / Vozmozhnosti interfeisa «mozg­komp'yuter¼ v korrektsii postinsul'tnykh kognitivnykh narushenii.

In recent years, brain-computer interfaces have been widely used in neurorehabilitation, and an extensive database of results from clinical studies conducted around the world has been accumulated, demonstrating their effectiveness in restoring motor function after a stroke. Currently, their use in post-stroke cognitive impairment is expanding. This article discusses the potential and prospects for using brain-computer interfaces for the treatment of cognitive disorders, reviews the experience of using it, presents the results of clinical studies in stroke patients, evaluates the possibilities of using this technology, describes the prospects, new directions of work on studying its effects.

[Effectiveness of brain-computer interfaces and cognitive training using computer technologies in restoring cognitive functions in patients after stroke]. / Effektivnost' primeneniya interfeisov «mozg­komp'yuter¼ i kognitivnykh treningov s ispol'zovaniem komp'yuternykh tekhnologii v vosstanovlenii kognitivnykh funktsii u patsientov posle insul'ta.

OBJECTIVE: To study the effectiveness of brain-computer interfaces (BCI) and cognitive training using computer technologies in restoring cognitive functions in poststroke patients. MATERIAL AND METHODS: Thirty-four stroke patients (mean age 59.3±10.8 years) with stroke duration of 5.1±4.7 months, were included. To assess the effectiveness of treatment, patients before and after treatment were tested using memorization of words according to the method of Luria A.R. «10 words¼, the Montreal Cognitive Assessment Scale (MoCA), the Clock Drawing Test (CDT). All patients received standard rehabilitation therapy (exercise therapy, physiotherapy, sessions with a speech therapist-neuropsychologist). Patients of the first group additionally received training on the «Neurochat¼ complex, patients of the second group - on the «Exokist-2¼ complex, patients of the third group - cognitive training according to standard programs using computer technology and visual material. RESULTS: Patients of the three groups showed a significant improvement in the total MoCA score: in the 1st and 2nd groups - p<0.01, in the 3rd group - p<0.05. According to CDT, there was a significant change in the 2nd group (p=0.018). The Luria method «10 words¼ revealed an improvement in memory in all groups (p<0.01, p<0.05), being more pronounced in the 1st and 2nd groups. CONCLUSION: The effectiveness of BCI in restoring cognitive functions in patients after a stroke in comparison with cognitive training without BCI has been demonstrated. However, there are reasons to believe that various BCIs have a specific effect on cognitive functions and have their own target group.

[The impact of a comprehensive support response biofeedback program on patient recovery and quality of life after stroke]. / Vliyanie kompleksnoi programmy na osnove biologicheskoi obratnoi svyazi po opornoi reaktsii na vosstanovlenie patsientov i kachestvo zhizni posle insul'ta.

OBJECTIVE: To assess the impact of a comprehensive support response biofeedback program on patient recovery and quality of life after a stroke during a six-month follow-up. MATERIAL AND METHODS: One hundred poststroke patients were followed-up during six months after a course of treatment using a comprehensive program based on biofeedback on the support reaction, including stabilometric training «standing on the platform¼; training using a power joystick for a hand on a static stabilometric platform; therapeutic gymnastic exercises for the upper shoulder girdle. RESULTS: Within six months after the course of treatment, there were no statistically significant changes in the motor function of the paretic hand according to the Fugle-Meyer and Ashworth scale. In neuropsychological testing after 3 months, the indicators on MoCA, Stroop, Symbols and Numbers, Schulte, Speech Fluency, and Kohs block design tests did not show negative dynamics. There was a decrease in indicators, which did not reach the values before treatment, after 3 months according to the Digit Span test, delayed recall according to the «memorizing 10 words¼ test by A.R. Luria After 6 month, there were no changes on MoCA, Symbols and Numbers, Schulte and Kohs block design tests. The decline after 6 months was observed on Speech Fluency, Stroop, Digit Span tests and Delayed Recall on the 10-Word Memory Test. At the same time, there was a positive dynamic of indicators of emotional status, activity of daily life and functional activity after 3 and 6 months of follow-up, the indicator of the quality of life of patients improved after 6 months. CONCLUSION: Persistent therapeutic effect of the complex program carried out for 6 months was noted in relation to motor disorders in the paretic hand. There is an improvement in the emotional state, functional status, quality of life. When assessing cognitive functions, the therapeutic effect is stable for 3 months according to most scales. At the same time, the decrease in cognitive testing indicators on individual scales, in our opinion, determines the feasibility of repeated courses of treatment in three to six months in order to prevent the progression of disorders.

[Dynamics of recovery of cognitive deficit in patients in the early recovery period of ischemic stroke]. / Dinamika vosstanovleniya kognitivnogo defitsita u patsientov v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

OBJECTIVE: Study of the effectiveness of the use of the drug Ampasse in the process of complex rehabilitation in patients in the early recovery period of ischemic stroke at the second (stationary) stage. MATERIAL AND METHODS: The study included 60 patients, 28 women and 32 men, aged 43 to 76 years (mean - 58.4±9.1 years), in the recovery period after suffering a stroke in the period from 1 to 12 months (on average - 4.7±3.5 months). All patients received complex rehabilitation, patients of the 1st group received additional intravenous injections of the drug Ampasse 25 mg (5.0 ml), 15 injections. Patients of the 2nd group (n 0) did not receive Ampasse. To assess cognitive functions, the following tests were used: the Montreal Cognitive Assessment Scale (MoCA), Stroop's test, subtest 9 of the Wechsler test, Koos cubes (CC), the severity of anxiety and depression was assessed, and motor recovery was assessed by the hand motor activity test (ARAT). The assessment was carried out before the start of treatment and on the 21st day. RESULTS: There was a statistically significant increase in the score on the MoCA scale, in patients of the 1st group by an average of 2 points, in the 2nd group there was no significant dynamics, a statistically significant difference was found in the proportion of patients who had an increase in the MoCA index after the course of treatment in the 1st group. compared with the 2nd (χ2 - 22.528, p<0.001). Decreased the level of rigidity according to the Stroop test in patients of the 1st group compared with the 2nd (χ2 - 8.297, p=0.004). The number of patients who showed positive dynamics in the Koos cubes test in the 1st group was statistically significantly higher (χ2- 4.344, p=0.038). A statistically significant decrease in the level of depression was revealed in patients of the 1st group. The number of patients with improved motor function of the hand was greater in the 1st group of MG (χ2 - 4.286, p<0.039). CONCLUSION: In patients in complex therapy receiving intravenous administration of the drug Ampasse at a dose of 25 mg (5.0 ml) 15 administrations, a statistically significant improvement in cognitive functions was revealed according to MoCA tests, Stroop test, Koos Cubes, when compared with the comparison group. The use of Ampasse increased the effectiveness of cognitive and motor rehabilitation in patients with post-stroke disorders.

[The possibility of using integral indicators of thrombodynamics for the safety of rehabilitation treatment after a stroke]. / Vozmozhnost' ispol'zovaniya integral'nykh pokazatelei trombodinamiki dlya bezopasnosti reabilitatsionnogo lecheniya posle insul'ta.

OBJECTIVE: To assess the possibility of using the integral indicators of thrombodynamics to improve the safety of rehabilitation measures in patients in the recovery period of stroke. MATERIAL AND METHODS: A prospective study included 52 patients in the recovery period of stroke. To compare the effect of the intensity of physical activity on the change in the integral indicators of thrombodynamics in accordance with the objectives of the study, the patients were randomized into two groups. In the first group, patients received treatment, including physiotherapy, stabilometric trainings, neuropsychological tasks. Patients of the second group received complex treatment, including more intense physical activity with the use of cyclic exercises, biomechanotherapy. To assess the state of hemostasis, an integral thrombodynamics test was used, and the numerical parameters of the spatial dynamics of the growth of a fibrin clot were calculated. RESULTS: The state of compensated hypercoagulability was revealed in the majority of patients before the start of medical rehabilitation, despite taking antithrombotic therapy, which was evidence of the ineffectiveness of the therapy. At the same time, it was noted that it was its action, probably during the ongoing program of physical rehabilitation, that ensured the stability of the integral indicators of thrombodynamics and the absence of clinically significant unwanted thromboembolic complications. As a result of the analysis of the data in dynamics before and after treatment, a direct relationship was traced between the intensity of physical activity and the tendency to disturb the hemostatic balance. CONCLUSION: The intensity of physical activity during treatment undoubtedly influenced the state of hemostasis. The expediency of monitoring the dynamics of coagulation activity in patients in the recovery period of stroke has been demonstrated.

[Efficiency of a comprehensive program with biological feedback on support reaction in the restoring period of stroke]. / Effektivnost' kompleksnoi programmy s biologicheskoi obratnoi svyaz'yu po opornoi reaktsii v vosstanovitel'nom periode insul'ta.

OBJECTIVE: To study the effect of a comprehensive neurorehabilitation program based on biofeedback on the support response in poststroke patients. MATERIAL AND METHODS: The article presents the results of treatment of 59 patients after ischemic stroke. The program included training using a force joystick for the upper limb based on a static stabilometric platform with biofeedback according to the support reaction, training in the position of the patient standing on a stabilometric platform, exercise therapy. Patients in the control group received standard therapy. RESULTS: The use of the comprehensive program contributed to a statistically significantly better therapeutic effect, increased strength, and decreased spasticity in the paretic arm, decreased anxiety and depression, and improved cognitive functions compared with standard therapy in patients in the control group. CONCLUSIONS: We show the efficacy of comprehensive program based on biofeedback on the support response in the restoring period of stroke.

[Cognitive rehabilitation after stroke using non-pharmacological approaches]. / Kognitivnaya reabilitatsiya posle insul'ta s ispol'zovaniem nefarmakologicheskikh podkhodov.

Cerebral stroke is one of the leading causes of disability in the modern world. Despite the high efficacy of high-tech treatment methods, the issue of rehabilitation is extremely relevant for post-stroke patients. Much attention is paid to non-pharmacological approaches; their use in the treatment process seems to be very promising. The review presents therapeutic approaches aimed at increasing the plasticity of the brain, including rhythmic transcranial magnetic stimulation, direct current stimulation, training with a speech therapist-neuropsychologist, computerized cognitive training, biofeedback techniques for support response, electroencephalogram, high-tech approaches using virtual reality, interfaces brain-computer, art therapy, music therapy, various complexes of physical exercises.

[Independence of ischemic stroke patients after alteplase systemic thrombolytic therapy]. / Pokazateli nezavisimosti u bol'nykh s ishemicheskim insul'tom posle sistemnoi tromboliticheskoi terapii preparatami alteplazy.

OBJECTIVE: Was to determine the proportion of patients with ischemic stroke (IS) who achieved functional independence by the end of the hospitalization, among those who underwent systemic thrombolytic therapy (STT) with two different alteplase preparations (Actilyse and Revelisa). MATERIAL AND METHODS: An open, prospective observational non-interventional cohort study of the results of STT in patients with IS was carried out. The study included 195 patients, 123 men and 72 women aged 32 to 86 years, who received STT in the acute period of IS. Of these, 120 patients received Actilyse, 75 - Revelisa. RESULTS: Patients who achieved independence in movement (0-2 points on the modified Rankin scale (MRS)) among those who received STT with Actilyse and Revelisa, the value of the χ2 criterion was 0.014 (p=0.905), which showed that there was no statistical significance of the difference in the frequency of recovery of functional disorders on the MRS scale, in patients receiving STT with two different alteplase preparations. CONCLUSION: After STT with alteplase preparations, patients with IS experienced a significant improvement, which was expressed in a statistically significant decrease in the severity of neurological deficit and a decrease in the degree of disability. When comparing the results of STT with two different alteplase preparations, no statistically significant differences were found in terms of mortality, survival, and independence during the acute period of IS.

[Robotic recovery of walking function in patients in the early recovery period of stroke]. / Robotizirovannoe vosstanovlenie funktsii khod'by u bol'nykh v rannem vosstanovitel'nom periode insul'ta.

OBJECTIVE: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

[Multimodal stimulation in the neurorehabilitation of patients with poststroke cognitive impairment]. / Mul'timodal'naya stimulyatsiya v neiroreabilitatsii patsientov s postinsul'tnymi kognitivnymi narusheniyami.

Loss of functional activity after a stroke is a leading cause of disability in adults worldwide. Particular attention is currently being paid to post-stroke cognitive impairment. Approaches based on multimodal exposure are increasingly being used when planning rehabilitation programs, which makes it possible to comprehensively cover the entire spectrum of existing neurological disorders in patients and enables to achieve a more effective recovery of functional activity after a stroke.

[Poststroke cognitive impairment and the possibility of its nonpharmacological treatment with vestibular stimulation based on biological feedback to supporting reaction]. / Kognitivnye narusheniia posle insul'ta i vozmozhnosti ikh nefarmakologicheskoi korrektsii s primeneniem vestibuliarnoi stimuliatsii na osnove biologicheskoi obratnoi sviazi po opornoi reaktsii.

Cognitive impairment is common in poststroke patients. Today in rehabilitation programs the specialists use the vestibular stimulation including biological feedback to supporting reaction for treatment poststroke cognitive impairment. These studies show the relationship of vestibular function with memory, attention, spatial orientation, navigation, mental representation of three-dimensional space and other cognitive functions. It makes possible to build rehabilitation programs for patients with stroke.

[Laparoscopic rendezvous surgery for cholecystocholedocholithiasis]. / Laparoéndoskopicheskie vmeshatel'stva pri kholetsistokholedokholitiaze (tekhnika Rendezvous).

OBJECTIVE: To present a modified technique of laparoscopic surgery (Rendezvous technique) for cholecystocholedocholithiasis. MATERIAL AND METHODS: There were 41 patients with cholecystocholedocholithiasis who underwent hybrid single-stage laparoscopic surgery (Rendezvous technique) as an alternative to conventional two-stage approach. RESULTS: Two (4.8%) patients had elevated serum amylase level without signs of pancreatitis in postoperative period. Other 2 patients required redo transpapillary intervention due to residual stones. Laparoscopic interventions were successful in 95.2% of cases.

[Possibility of treatment of emotional and behavioral disorders in patients with stroke during rehabilitation]. / Vozmozhnost' korrektsii émotsional'nykh i povedencheskikh narushenii u patsientov s insul'tom v protsesse reabilitatsionnogo lecheniia.

AIM: To assess the effect of the comprehensive rehabilitation, which includes mechanotherapy and cognitive stimulation based on tablet technologies, on emotional and behavioral disorders in patients in the acute stage of ischemic stroke. MATERIAL AND METHODS: The study enrolled 100 patients admitted to the hospital in the acute stage of ischemic stroke. The patients were randomized into treatment and control groups. Patients of the treatment group (n=50) underwent daily robotic mechanotherapy using the MOTOmed movement trainer and tablet technologies for self-training to improve memory, perception, reaction, counting. Patients of the control group (n=50) received standard therapy. The functional state of patients was assessed with the Rankin modified scale. Psychometric scales (the Beck Depression and Anxiety Inventories) were used to measure emotional and behavioral disorders. RESULTS: The program of comprehensive rehabilitation in the acute stage of ischemic stroke helps to decrease emotional and behavioral disorders (p=0.0001). In patients of the treatment group, the severity of depressive disorders was lower at discharge from the hospital and continued to decrease for 6 months (p=0.001). The level of anxiety decreased over the study period (p=0.0001) compared with the patients of the control group who did not demonstrate improvement. Patients of the treatment group displayed better functional recovery reflected by significant changes in Rankin scale scores. CONCLUSION: The rehabilitation program, which includes mechanotherapy and cognitive stimulation based on tablet technologies, is an easy and accessible method for treatment of emotional and behavioral disorders in patients in the acute stage of ischemic stroke. The results are maintained during the study period with further improvement after 3 and 6 months.

[Usage of brain - computer interface+exoskeleton technology as a part of complex multimodal stimulation in the rehabilitation of patients with stroke]. / Primenenie tekhnologii neirointerfeis 'mozg - komp'iuter'+ékzoskelet v sostave kompleksnoi mul'timodal'noi stimuliatsii pri reabilitatsii patsientov s insul'tom.

INTRODUCTION: A study of 'neural interface brain - computer + exoskeleton' (BCI) technology in training of the movement imagination seems to be an interesting task in the restoration of higher mental functions of the patient. At the same time, it is necessary to evaluate the effectiveness of multimodal stimulation with the inclusion of various information channels, which should contribute to the stimulation of neuroplasticity and improve interhemispheric relationships. AIM: To study an impact of multimodal stimulation using BCI on the recovery of cognitive functions in post stroke patients. MATERIAL AND METHODS: Forty-four patients were examined and treated in the period of 2 months to 2 years after a stroke. In accordance with the purpose and objectives of the study, all patients were divided into two comparable groups, the main (n=22) and the comparison group (n=22). Patients of the main group underwent a program of complex multimodal stimulation, which included the use of procedures using BCI technology, cognitive training and training on a stabilometric platform with biological feedback on the base reaction and vibrotherapy. Patients of the comparison group had only training with the use of BCI. RESULTS: After the treatment, significantly better therapeutic results were observed in the form of improved memory, attention, visual and constructive skills in patients of the main group compared with patients of the comparison group. CONCLUSION: The issues of cognitive training using BCI technology are currently a new direction of neurorehabilitation, and the obtained encouraging results indicate the prospects of this direction.

[The efficacy of systemic thrombolysis in patients with cardioembolic stroke]. / Éffektivnost' sistemnoi tromboliticheskoi terapii u bol'nykh s kardioémbolicheskim insul'tom.

AIM: To compare the efficacy and safety of systemic thrombolytic therapy (STLT) in patients with cardioembolic stroke (CE) versus other pathogenic subtypes of ischemic stroke (IS). MATERIAL AND METHODS: The study included 147 patients, 62 women and 85 men (mean age - 62.9±0.8 years) including 37 patients (25.2%) with CE subtype of IS (group 1) and 110 patients with other pathogenetic subtypes of IS (group 2). NIHSS and Rankin scale were used to assess patient's neurological status. RESULTS: One hundred and twenty-six patients were discharged, 21 (14.3%) died. In 11 patients, the cause of death was the development of symptomatic hemorrhagic transformation (SHT). There were no significant differences in the lethality between groups 1 and 2. Tolerability to STLT in these groups did not differ as well. As a result of treatment, the condition of patients surviving to the end of the hospital stay improved, which was reflected in a significant decrease in the NIHSS scores, despite the higher NIHSS scores in group 1. CONCLUSION: The results confirm the efficacy of STLT in patients with CE IS and indicate the increase in the frequency of favorable functional recovery in these patients.

[The efficacy of cocarnit in diabetic neuropathy]. / Éffektivnost' preparata kokarnit pri diabeticheskoi neiropatii.

AIM: To study the efficacy of the complex therapy, including cocarnit (group B vitamins, triphosadenine and nicotinamide), of diabetic neuropathy. MATERIAL AND METHODS: Forty-one patients with diabetes mellitus type 2 and distal symmetric sensorimotor polyneuropathy were examined. Patients were divided into 2 groups. Patients of the main group (n=26) received complex therapy, including cocarnit, and patients of the comparison group (n=15) received standard treatment. RESULTS AND CONCLUSION: The positive dynamics based on the VAS (р=0.0001), TSS (р=0.0001), NSS (р=0.001), NDS (р=0.0431), SF-36 (р=0.0008), electroneuromyographic results and glycated hemoglobin levels was observed in the main group. In patients of the comparison group, the positive dynamics was instable; the scores of clinical scales did not reach statistical significance. The results suggest the use of cocarnit in the complex treatment of patients with diabetic neuropathy.

[Restoring of the speech functions in patients with aphasia in the early rehabilitation period of ischemic stroke]. / Vosstanovlenie rechevykh funktsii u bol'nykh s afaziei v rannem reabilitatsionnom periode ishemicheskogo insul'ta.

AIM: To study the efficacy of combined therapy including daily sessions and two 10-day injections of the drug cellex in patients with aphasia in the early rehabilitation period of ischemic stroke (II). MATERIAL AND METHODS: Forty patients in the early rehabilitation period of II in the basin of the left middle cerebral artery with moderate to severe aphasia were studied. Twenty patients received combined therapy, including daily sessions with a speech therapist-aphasiologist within 10 days using the improved method, then a self-study using educational materials and two 10-day injections of cellex. Other 20 patients received only speech therapy. To assess the efficacy of therapy, the automated "Program of examination of patients with aphasia", Goodglass-Kaplan scale, modified Rankin scale were used. RESULTS: There was a significant improvement of speech functions, communicative abilities and functional recovery (p<0.01) in patients of both groups. However, a significantly greater level of rehabilitation (p<0.05) was noted in patients treated with combined therapy included two courses of cellex. CONCLUSION: The results allow to recommend the inclusion of cellex in the complex rehabilitation of patients with post-stroke speech disorders.

[Diabetic asymmetric proximal neuropathy]. / Diabeticheskaia asimmetrichnaia proksimal'naia neiropatiia.

AIM: To study the prevalence, clinical features and treatment of diabetic asymmetric proximal neuropathy (DAPN). MATERIAL AND METHODS: Four hundred and forty-five patients with diabetes mellitus (DM), 257 women and 188 men, mean age 47.6±0.5 years, including 163 patients with DM type I and 282 with DM type II, were examined. RESULTS AND CONCLUSION: Distal symmetric sensory motor polyneuropathy was found in 62% of the patients, autonomic neuropathy in 25.6%, somatic mononeuropathy in 28.5%, DAPN in 7.9%. DAPN was more frequent in patients with DM type II (9.6), with poor control of glycemia and DM duration more than 5 years. Pain and paresthesia in a zone of innervation of several roots and nerves, amyotrophy that spread beyond the definite myotome were key symptoms of DAPN. The efficacy of double therapy of neuropathic pain (pregabalin and duloxetine) and vitamin B complex was shown. A role of glucocorticoids and normal human immunoglobulin in treatment of DAPN is discussed.