Abstract
INTRODUCTION. Safety and the personal dosing of physical activity are the main aspects of medical rehabilitation in stroke patients.
AIM. To study the possibilities of assessment and correction of cardiac risks by ECG telemonitoring during complex medical rehabilitation of patients in early and late recovery period of ischemic cerebral stroke (IS).
MATERIALS AND METHODS. The study included 60 patients in the early and 60 patients in the late recovery period of IS aged 45 to 75 years. During each procedure of complex medical rehabilitation with multimodal impact on impaired motor functions, the ECG parameters of patients were monitored using a portable telecardiocomplex (ECG Dongle cardioflash). Real-time ECG analysis allowed individual correction of the rehabilitation load.
RESULTS AND DISCUSSION. ECG changes were analyzed in subgroups of patients taking into account the pathogenetic subtype of IS according to TOAST. The high comorbidity of patients with IS according to the cardiac profile was confirmed (arterial hypertension 64.1 %, dislipidemia 68.3 %, obesity 41.6 %, ischemic heart disease 15 %). There were clinically significant ECG changes: ventricular extrasystole in RVP in 11.7 % of cases, PVP in 8.3 %; atrial fibrillation in RVP in 16.7 %, in PVP in 10 % of patients, conduction abnormalities in 15 % and 11.7 % cases, respectively. Most ECG abnormalities were clinically asymptomatic. Most of the patients had marked abnormalities of cardiac activity regulation, also clinically asymptomatic. Individual correction of the motor rehabilitation program in patients with clinically significant ECG changes allowed to fully complete the medical rehabilitation course in patients with IS.
CONCLUSION. The use of remote TMT in assessing cardiac safety in patients after IS provides a personalized approach and allows for a reliable assessment of cardiac risks, including in comorbid patients, which expands the prospects and possibilities of their rehabilitation.
Publisher
National Medical Research Center For Rehabilitation And Balneology
Subject
Rehabilitation,Physical Therapy, Sports Therapy and Rehabilitation
Reference29 articles.
1. Басенцова Н. Ю., Шишкин А. Н., Тибекина Л. М. Цереброкардиальный синдром и его особенности у пациентов с острым нарушением мозгового кровообращения. Вестник Санкт-Петербургского Университета. 2017; 12(1): 31–47. https://doi.org/10.21638/11701/spbu11.2017.103 [Basentsova N.Yu., Shishkin A. N., Tibekina L. M. Cerebrocardial syndrome and its features in patients with acute cerebrovascular accident. Vestnik SРbSU. Medicine. 2017; 12(1): 31–47. https://doi.org/10.21638/11701/spbu11.2017.103 (In Russ.).]
2. Акжигитов Р. Г., Алекян Б. Г., Алферова В. В., Белкин А. А., Беляева И. А., Бойцов С. А., Вознюк И. А., Виноградов О. И., Герасименко М. Ю., Гераскина Л. А., Гехт А. Б., Гусев Е. И. Клинические рекомендации. Ишемический инсульт и транзиторная ишемическая атака у взрослых. Доступно на: https://www.neurology.ru/obrazovanie/lektsii-master-klassy-i-drugie-nauchno-prakticheskie-i-obrazovatelnye-meropriyatiya/klinicheskie-rekomendacii-ishemicheskiy-insult-i-tranzitornaya-ishemicheskaya-ataka-u-vzroslyh.html?ysclid=l9ruyfs1w2905659550 [Akzhigitov R. G., Alekyan B. G., Alferova V. V., Belkin A. A., Belyaeva I. A., Boitsov S. A., Voznyuk I. A., Vinogradov O. I., Gerasimenko M.Yu., Geraskina L. A., Geht A. B., Gusev E. I. Clinical recommendations. Ischemic stroke and transient ischemic attack in adults. Available at: https://www.neurology.ru/obrazovanie/lektsii-master-klassy-i-drugie-nauchno-prakticheskie-i-obrazovatelnye-meropriyatiya/klinicheskie-rekomendacii-ishemicheskiy-insult-i-tranzitornaya-ishemicheskaya-ataka-u-vzroslyh.html?ysclid=l9ruyfs1w2905659550 (In Russ.).]
3. Winstein C. J., Stein J., Arena R. et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2016; 47(6): e98-e169. https://doi.org/10.1161/STR.0000000000000098.
4. Cristian A., Green J. Patient safety and quality improvement in rehabilitation medicine. Physical Medicine and Rehabilitation Clinics of North America. 2012; 23(2): 221–230. https://doi.org/10.1016/j.pmr.2012.02.001.
5. Сидякина И. В., Воронова М. В. Индивидуализированный подход к реабилитации пациентов с центральной дисфагией. Физиотерапия, бальнеология и реабилитация. 2016; 15(3): 137–141. https://doi.org/10.18821/16813456-2016-15-3-137-141 [Sidyakina I. V.,Voronova M. V. Individualized approach to rehabilitation of patients with central dysphagia. Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2016; 15(3): 137–141. https://doi.org/10.18821/16813456-2016-15-3-137-141 (In Russ.).]