[Vestibular rehabilitation for peripheral vestibular hypofunction: an interdisciplinary consensus]. / Vestibulyarnaya reabilitatsiya pri perifericheskoi vestibulyarnoi gipofunktsii: mezhdistsiplinarnyi konsensus.

The literature review presents approaches to the management of patients with vestibular disorders. The principles of organization of vestibular rehabilitation in peripheral vestibular hypofunction, indications for appointment, factors influencing its implementation, technique, methods of evaluating effectiveness are considered in detail. Attention is drawn to the fact that the selection of exercises and the duration of vestibular rehabilitation is carried out individually and depends on many factors, including the nature of vestibular deficiency and the specific characteristics of the patient. The possibilities of using additional pharmacological therapy with histamine preparations, which can accelerate the onset of vestibular compensation, are shown. It is noted that vestibular rehabilitation is a safe and effective method of treating peripheral vestibular hypofunction and should be recommended to patients of all ages with vestibular disorders leading to limited social and physical activity.

Motor Decision-Making as a Common Denominator in Motor Pathology and a Possible Rehabilitation Target.

Despite the substantial progress in motor rehabilitation, patient involvement and motivation remain major challenges. They are typically addressed with communicational and environmental strategies, as well as with improved goal-setting procedures. Here we suggest a new research direction and framework involving Neuroeconomics principles to investigate the role of Motor Decision-Making (MDM) parameters in motivational component and motor performance in rehabilitation. We argue that investigating NE principles could bring new approaches aimed at increasing active patient engagement in the rehabilitation process by introducing more movement choice, and adapting existing goal-setting procedures. We discuss possible MDM implementation strategies and illustrate possible research directions using examples of stroke and psychiatric disorders.

[Pathophysiological mechanisms of the therapeutic action of alternating electromagnetic fields in the treatment of osteoarticular pathology]. / Patofiziologicheskie mekhanizmy terapevticheskogo deistviya peremennykh elektromagnitnykh polei v lechenii kostno-sustavnoi patologii.

Treatment of osteoarticular pathology with an alternating electromagnetic field (AEMF) is used today as a promising, non-invasive and safe strategy of physiotherapy. It has been shown that the action of alternating electromagnetic fields on the musculoskeletal system triggers signaling cascades that effectively contribute to the restoration of bone and articular tissue. The pathophysiological mechanisms underlying the cellular and subcellular effects of stimulation by an alternating electromagnetic field during the restoration of bone and articular tissue are considered. It was pointed out the several key signaling pathways involved in the restoration of bone and articular tissue under the influence of electromagnetic fields with an analysis of the potential for therapeutic application of electromagnetic fields alone or in combination with other available therapies.

[Current issues of treatment and rehabilitation of patients with neurological disorders and the consequences of COVID-19. Resolution of Advisory Board]. / Osnovnye napravleniya lecheniya i reabilitatsii nevrologicheskikh proyavlenii COVID-19. Rezolyutsiya soveta ekspertov.

Last year the global medical community faced the pandemic of the new coronavirus infection caused by SARS-CoV-2. To date, there is considerable expert experience, which indicates that the brain, along with the corresponding respiratory system, is a target organ for a new coronavirus infection. Moreover, a number of symptoms from the central and peripheral nervous system can persist for several weeks, months, and even tens of months. To designate such protracted clinical conditions, a new definition was introduced: «Post-COVID-19 Condition¼. Advisory Board of Neurologists and Rehabilitation Therapists met to, discuss of practical experience and taking into account scientific information about COVID-19, which was available at the time of the meeting, to develop unified approaches for the management of patients with neurological complications and the consequences of a new coronavirus infection. The Advisory Board worked out a resolution in which formulated the tactics of managing patients with neurological manifestations of COVID-19. The substantiation of the importance and expediency of the development and implementation of a special program of clinical examination of patients who have undergone COVID-19, which would include a clinical examination with a detailed assessment of cognitive functions to early identification and diagnosis of neurodegeneration and subsequent therapy, is given.

[Clinical and anamnestic data that affect the outcome of rehabilitation on virtual reality in patients with stroke]. / Kliniko-anamnesticheskie dannye, vliyayushchie na iskhod reabilitatsii v virtual'noi real'nosti u patsientov, perenesshikh tserebral'nyi insul't.

OBJECTIVE: To determine the impact of clinical and anamnestic data of stroke patients on the rehabilitation process's outcome in virtual reality (VR). To study parameters of postural stability, gait, daily activity and affective functions during motor training in the immersive high-tech polymodal VR system. MATERIAL AND METHODS: We examined 34 patients (16 women, 18 men, mean age 51.9±12.5) who had a stroke at least 2 weeks ago and had a degree of disability no more than 3 points on the Rankin scale, mainly due to movement disorders. The patients underwent training in the VR system (Grail, Motekforce) for 10 sessions. Before and after the end of the training, the patient's condition was diagnosed, including indicators of motor and daily activities, affective functions, as well as an instrumental assessment of balance and gait in VR. RESULTS: After training up to 62% of patients showed improvements in physical activity, up to 41% - in daily living activities, up to 73% - in the affective sphere. The results of multiple linear regression analysis showed that gender, the type of stroke and the side of the brain lesion are significant predictors for the rehabilitation of postural stability, while the type of stroke and the period of recovery after stroke predict the restoration of the affective sphere. CONCLUSION: Groups of patients stratified by gender, the type of stroke, the side of the brain lesion and recovery period, for whom training in the VR system was most effective, are identified. Based on the results of the study, the authors suggest the criteria of inclusion of VR in the individual rehabilitation program of patients with stroke.

[Current issues in the rehabilitation of stroke patients against the background of a new coronavirus infection (COVID-19). Resolution of the Council of Experts]. / Aktual'nye voprosy reabilitatsii patsientov s insul'tom na fone novoi koronavirusnoi infektsii (COVID-19). Rezolyutsiya Soveta ekspertov.

The pandemic of the new coronavirus infection caused by SARS-CoV-2 has forced to reconsider the methods of rehabilitation of patients with emergency conditions, including neurology. The Council of Experts of Neurologists and Rehabilitation Therapists gathered to develop unified approaches to manage stroke patients based on a discussion of practical experience and, taking into account the scientific information on COVID-19 that was available by the time of the meeting. Stroke is a serious disabling condition that requires maximum rehabilitation efforts at all stages of medical care. In the context of the SARS-CoV-2 coronavirus epidemic, the process of medical rehabilitation and the routing of patients with stroke is undergoing major changes. Combining COVID-19 and stroke requires new approaches to rehabilitation and patient management. During the meeting, a resolution was developed in which the experts formulated the tactics of medical rehabilitation of patients with stroke and COVID-19 at the first and second stages. The arguments of the importance and practicability of carrying out measures of medical rehabilitation at the third stage is given and the need to continue consultations on the indicated topic is revealed.

[Brain-computer interface-based motor imagery training for patients with neurological movement disorders]. / Pilotnoe issledovanie ideomotornogo treninga v konture interfeisa mozg-komp'iuter u patsientov s dvigatel'nymi narusheniiami.

AIM: To study the electric brain activity during motor imagery task in the brain-computer interface (BCI) in motor-disabled patients to determine the optimal ways for using BCI-based ideomotor training in medical rehabilitation. MATERIAL AND METHODS: The study included 26 patients with arm motor dysfunction caused by a stroke or a spinal cord injury. They were involved in motor imagery training in the BCI. The power and localization of electroencephalographic (EEG) event-related desynchronization during imagery of different arm movements were measured. The accuracy in the two-command BCI was assessed. RESULTS AND CONCLUSION: The pattern of imagery-related EEG desynchronization showed the typical localization for such tasks. Despite the fact that the power of EEG reactions during motor imagery in motor-disabled patients was on average lower than in healthy subjects during a similar task, all the patients were able to achieve high accuracy in the two-command BCI system after several (at least three) training sessions. Our results demonstrate the great potential for using BCI-based motor imagery training for neurorehabilitation of patients with motor dysfunctions.

[The restoration of the shoulder joint function in the patients presenting with hemiparesis during the acute phase of hemispheric stroke]. / Vosstanovlenie funktsii plechevogo sustava u patsientov s gemiparezom v ostryi period polusharnogo insul'ta.

The impaired function of the shoulder joint resulting from cerebral stroke is a common disorder involving permanent total disability as well as impaired capability of self-care. The functional pathological changes in the shoulder joint and the dynamics of the patients' health status during the acute period of cerebral stroke remain virtually unexplored. AIM: The objective of the present study was to obtain a deeper insight into the process of recovery of the movements in the shoulder joint of the patients presenting with hemiparesis during the acute period of hemispheric stroke based on the results of the analysis of the biomechanical data and the targeted training with biofeedback (BFB). MATERIAL AND METHODS: The study included three groups comprised of 25 subjects each. One (control) group included the subjects having neither neurological nor orthopedic pathology. The second group consisted of the patients receiving the conventional treatment in the combination with therapeutic physical exercises (TPE). Group 3 was composed of the patients given the standard course of conventional and physical (TPE) therapy complemented by biofeedback training (the TPE/BFB group). The study included clinical investigations and biomechanical registration of the movements of the shoulder joints and trunk. RESULTS: The results of the study gave evidence that the patients presenting with hemiparesis during the acute period of hemispheric ischemic stroke including those treated with the application of the active means and methods of rehabilitation, such as BFB training, showed no appreciable dynamics of the parameters being evaluated with the use of the relevant clinical scales. The biomechanical study has demonstrated that the movements in the shoulder joints (in a single plain) of the patients comprising the control group are characterized by the presence of the main component with a maximum amplitude in the plane of this movement and additional components (in other planes with a significantly lower amplitude); they are accompanied by the ancillary movements of the trunk. Functionally, the condition of paresis at the level of the shoulder joint is characterized by a decrease in the amplitude of the primary movement and the increase of one of the additional amplitudes, with the growing amplitude of the auxiliary movements of the trunk. The biomechanical methods for the objective assessment have revealed the following functional changes in the shoulder joints: the 6% improvement of flexion in the group of the patients treated with the use of therapeutic physical exercises and the 10% improvement in those treated with the combination of TPE and BFB. Moreover, abduction in the patients of these two groups improved by 4% and 9% respectively. CONCLUSIONS: The method for the study of kinematics of the movements in the shoulder joints appears to be most sensitive and informative for the purpose of diagnostics of disorders of the motor function and assessment of the process of its restoration in the patients presenting with hemiparesis during the acute period of hemispheric stroke.

[Results of implementation of a 'Complex of measures to improve medical care for patients with stroke in the Russian Federation']. / Rezul'taty realizatsii 'Kompleksa meropriiatii po sovershenstvovaniiu meditsinskoi pomoshchi patsientam s ostrymi narusheniiami mozgovogo krovoobrashcheniia v Rossiiskoi Federatsii'.

Vascular diseases of the brain and heart are the main cause of death and disability of the population of the Russian Federation. The social and economic burden of acute cerebral circulation disorders necessitated the development of a national program for the care of patients with acute vascular diseases. As a result of the implementation of a set of measures to improve medical care for patients with stroke over the past decade, the regions of the Russian Federation managed to create an 'insult network', equip the departments with high-tech diagnostic and therapeutic equipment, and train medical personnel. Due to the implementation of modern methods of treatment of stroke, the rates of disability and mortality from stroke have decreased.

[The dynamics of shoulder joint function in patients with hemiparesis in the acute period of carotid stroke]. / Dinamika funktsii myshts plechevogo poiasa u bol'nykh s gemiparezom v ostrom periode karotidnogo insul'ta.

AIM: To evaluate the recovery of shoulder joint function in patients with hemiparesis in the acute period of hemispheric stroke on the basis of the analysis of electromyography (fEMG) of the muscles of this region before and after rehabilitation measures, including targeted training with biofeedback (BFB). MATERIAL AND METHODS: Three groups of 25 people each were studied. Patients of the physical therapy (PT) group received standard treatment and physical therapy; patients of the PT+BFB group received BFB training in addition to PT; the control group consisted of people without neurological and orthopedic symptoms. A clinical study and EMG of the muscles of the shoulder girdle during testing movements was performed. RESULTS: On the side of paresis, the function of muscles was characterized by a decrease in the bioelectric activity (movement amplitude was decreased as well) and later phase of the maximum EMG activity compared to the norm. The time of maximum EMG activity had a trend towards the shift to the normal values during the treatment process, but the difference reached a statistically significant level not for all muscles and all movements. There were variants of the functions of the paretic muscles accompanied by the increased EMG activity. In the early stages (up to 21 days) of stroke, no significant changes in the EMG activity of shoulder girdle muscles were observed. The PT+BFB group showed better results than the PT group not only in the onset of activity, but also in the reduction of the amplitude when performing the same movement that indirectly suggested the more optimal inclusion of muscles in the motor act. In the period of acute hemispheric stroke, there were changes not only in the EMG activity of muscles of the affected side, but also of the contralateral side. CONCLUSION: A fEMG of the muscles is a more sensitive and informative method of the diagnosis of disorders of motor function and assessment of recovery process of the muscles of the shoulder joint in patients with hemiparesis.

[Investigation of risk factors of cardiovascular events by the interregional assistance fund of relatives of stroke patients].

We have analyzed the results of the clinical and laboratory study of 1070 people in 7 regions of the Russian Federation, including 222 (20.7%) men and 848 (79.3%) women aged from 19 to 94 years (mean age 57.15±13.39 years). It has been shown that 6.8% were smokers and 31.5% were alcohol abusers. Regular physical training (>30 min/day) was noted in 45.7%. Symptoms of asthenia were found in 73.3%. The level of knowledge on risk factors of stroke was estimated as: arterial hypertension (68.6%), ischemic heart disease (47.5%), heart rhythm disorders (27.0%), thrombosis of low extremities (26.8%). Mean values of arterial pressure were 140/80 mm Hg, heartbeat rate -- 74 per min. Mean value of BMI was 28.67 kg/m(2), BMI was higher than 30 in 41%. Hyperglycemia >6.2 mmol/l was recorded in 28%, hypercholesterolemia >6.2 mmol/l in 26%. Stenoses of inner carotid arteries were found in 49.2%: less than 50% diameter stenosis was in 32.8%, 50--70% in 11.8% and >70% in 4.6%. Antihypertensive drugs were used by 66.8%, antiaggregants - by 31.2% and statins by 31.2%. Knowledge about stroke was demonstrated by 81.8%, about stroke symptoms -- 58.5%, about the appropriate actions to be taken in the case of a stroke -- 48.5%. The low risk of stroke was observed in 33.2%, moderate risk in 37.3%, high-risk in 24.6% and critical risk in 4.9%.

[A complex study of the movement biomechanics in patients with post-stroke hemiparesis].

The authors present results of a pilot study on biomechanics of non-cyclic movements of the human consequent verticalization in the ontogenesis of patients with post-stroke hemiparesis (10 patients in the acute stage of cerebral stroke) and 10 healthy volunteers without neurologic and orthopedic pathology. Some movements of therapeutic exercises Balance (a model of ontogenetic kinesitherapy) have been selected for the study. Cinematic parameters have been recorded using a system of motion 3D video analysis, a kinematic model was build in accordance to standard protocols. The skin (native and straightened) electromyogram (EMG) was recorded synchronously with kinematic data using 16-channel electromyography from the following pairs of muscles: mm. sternocleido-mastoideus, trapezius (горизонтальная порция), biceps brachii, triceps brachii, rectus femoris, adductor magnus. Major differences in the EMG picture between patients and controls were: 1) the EMG "monotony" with the involvement of multiple additional muscles in locomotions with the prevalence of the peculiar "tonic" muscle activity (low amplitudes without distinct peaks), stretching along the whole cycle of movement. In controls, EMG demonstrated variability and had mostly "phasic" character with distinct 1 or 2 peaks; 2) the asymmetry of EMG profile in symmetric movements. i.e. when performed simultaneously from the right and from the left sides. The latter feature may be considered as predictive because it was never found in healthy people. It allows to identify objectively weak muscles even in the absence of visible parethis during the routine neurological examination.

[Clinical-electrophysiological characteristics of the cognitive sphere in patients in the acute period of the first cerebral ischemic stroke].

A neuropsychological and neurophysiological study using computed EEG was carried out in 31 stroke patients who did not have a cognitive impairment according to MMSE. Thirty age-matched patients with the same risk factors without a history of stroke were included into the control group. The examination of the control group was performed only once. The examination of stroke patients was performed on days 1, 7 and 21. It was shown that cognitive neurodynamic disturbances (memory disorders and the visual memory decrease) and bioelectrical brain activity disturbances (the decrease in a- and beta band activities and the increase of theta-band power) occurred from the first day and lasted during the acute stroke period even after the improvement of neurological status.

[Passive tilting in patients in the acute period of cerebral stroke].

Passive tilt table test is one of the methods of early rehabilitation in the most acute and acute periods of stroke. We included 36 patients with stroke: 17 patients underwent passive tilting using "Lojer 1445YH" (a main group), 19 patients underwent changing position with a functional bed (a control group) on days 1, 2, 3, 5, 7, 14 and 21 after the onset of disease. Some patients were intolerant to passive tilting due to decreasing of systolic blood pressure to more than 20 mm Hg in the first 48 h after stroke. Such patients presented inadequate autonomic tests, had severe neurological deficit on the NIHSS and low heart rate variability (SDNN (standart deviation NN intervals): 19,4 +/- 4,3 ms vs 31,8 +/- 12,6 ms; TP (total power): 483,4 +/- 177,7 ms2 vs 1227,1 +/- 865,8 ms2; p< or =0,05). At the end of the first week after stroke, patients from the main group had higher indices of heart rate variability compared with the control group. Functional outcomes on the Barthel Index and the modified Rankin Scale were better in the main group as well at the 14th day, the between-group difference being the most marked at the 21st day. Passive tilting may be used as one of the methods of early rehabilitation that facilitates abilities of patients and improves functional outcomes provided a careful monitoring of health condition and blood pressure of a patient during the session.

[Modern approach to gait restoration in patients in the acute period of cerebral stroke].

An objective of the study was to work out a complex program of gait restoration in patients with stroke using robot-driven mechanized gait trainers. The study included patients in the acute period of stroke (the mean age 59+/-10,4 years) who were not able to walk without assistance; 53 patients of the main group and 25 patients of the control group. The mean interval from the disease onset to the beginning of gait retraining sessions with mechanized gait trainers was 14+/-1,6 days depending on the adequacy of functional probes. The restoration program included everyday 30 minute sessions of exercise therapy. Patients of the main group received 20 min sessions using mechanized gait trainers Motomed Viva 2 and Gait Trainer 1 (GT1) with continuous monitoring of blood pressure and cardiac beat frequency. The number of sessions with GT1 was from 5 to 12, mean 7+/-1 sessions. After the complex restoration treatment, significant positive changes on scales of standing balance, functional categories of gait, Berg, Barthel (p< or =0.01) were observed in patients of the main group compared to controls. All patients of the main group became able to walk with a support or independently. The significant decrease (p< or =0.05) of a number of patients with disorders of proprioceptive sensitivity (from 37,7 to 9,4%) and with ataxia of the low extremities (from 37 to 11,3%) was observed in the main group, while no changes were seen in the control group. It has been concluded that the complex use of reflex kinesitherapy and robot-driven mechanotherapy in patients in the acute period of stroke allows to increase the functional activity and the level of self-service already prior to the discharge from hospital.

[The use of a robot-assisted Gait Trainer GT1 in patients in the acute period of cerebral stroke: a pilot study].

An aim of the study was to evaluate efficacy of using Gait Trainer GT1, a robot-assisted gait trainer with a system of body-weight support, for the rehabilitation of gait in patients in the acute period of cerebral stroke. A main group included 30 patients in the acute period of ischemic and hemorrhage stroke and a control group--20 age- and sex matched patients. Patients of both groups had daily kinesitherapy sessions with a rehabilitator. Patients of the main group had additional sessions on the Gait Trainer GT1 from the moment of functional readiness to adequate orthostatic probe. Efficacy of rehabilitation was assessed in the four following phases: the first verticalization of patient in the standing position, adaptation of patient to the standing position, walking with assistance, independent walking. Muscular power (scores) in all muscles of low extremities, muscle tonus (the Ashfort scale), amplitude of tendinous reflexes on the reflexes scale, sensory disturbances and discoordination syndromes (specially elaborated scales), pathological positions in the axial muscular system and extremities, functional status (a steadiness scale, the Berg balance scale, the Barthel scale, 5 m test) were assessed in each phase. Stabilometry was conducted for objective evaluation of vertical balance function. The duration of sessions on GT1 and a number of exercises were depended on the patient's tolerability to physical activity. Percentage of relief was determined by the ability of a patient to balance in the standing position. Each patient had 8-10 sessions. A significant improvement of the functional status: ability to balance in standing position, walking, increase of self-care skills were observed in both groups. No significant differences in the level of functional improvements were found compared to the control group. However some peculiarities of the rehabilitation of primary neurologic deficit were observed during CT1-trainings: the normalization of muscle tonus both in spastic and hypotonic muscles, predominate rehabilitation of flexor muscular system (p = 0.005), significant improvement of deep and surface sensitivity (p < 0.005). The stabilometric data revealed the normalization of strategy of vertical posture support--from hip to ankle (p = 0.001), proprioceptive control of balance by the Romberg coefficient (p = 0.005). Robot-assisted gait trainers are commonly used in trainings of step patterns in highly disabled patients who are not able to walk without assistance. These peculiarities of the rehabilitation of primary neurologic deficit during the GT-trainings allowed to use a differential approach to a candidate selection for the sessions.

[Principles of early rehabilitation of patients with stroke]. / Printsipy rannei reabilitatsii bol'nykh s insul'tom.

Basing on general pathophysiological data, the main outlines and principles of early rehabilitation of patients with acute disturbance of cerebral blood flow are considered. Clinical ENMG analysis of peripheral neuromuscular apparatus in 32 patients with right- and left-side location of the lesion in acute and early rehabilitation periods of ischemic stroke is presented. Different variants of ENMG interrelations between paretic and intact extremities and their correlations with functional rehabilitation degree are shown. Different sanogenetic mechanisms of movement functions rehabilitation in patients with right- and left-side lesions are hypothesized. The results of early rehabilitation of patients with stroke in neurological clinic of Russian State Medical University (General Municipal Hospital N20) are presented.