Modern approaches to the development of rehabilitation programs for increasing muscle strength and volume of motion in the limbs in patients after ischemic stroke

Abstract

The paper presents an analysis of the data obtained on the effectiveness of the inclusion of a pulsed low-frequency electrostatic field in the standard complex of medical rehabilitation in the long-term period in 60 patients who had an ischemic stroke with movement disorders in the form of hemiparesis with an increase in muscle tone by the type of spasticity, which were divided into 2 comparable clinically — functional characteristics of the group: the main group — 30 patients who underwent a course of massage with a pulsed low-frequency electrostatic field from the «Khivamat» apparatus in addition to the standard rehabilitation complex, consisting of exercise therapy, medical massage, kinesitherapy and medication support, and the control group — 30 patients, who received only the standard complex of medical rehabilitation and drug therapy. For a comparative assessment of muscle strength and range of motion in the extremities in patients after ischemic stroke in the initial state and after the course of treatment, we used the modified Ashfort spasticity scale (MAS), Bartel’s index, and goniometry indices. Research results. Before treatment, all patients with post-stroke spasticity included in the study had impaired motor functions of the upper limb in the form of moderate hemiparesis with high muscle tone and changes in the amplitude of movement. In the initial state, all patients included in the study showed motor changes in functions in the form of moderate hemiparesis with muscle hypertonicity, a decrease in the amplitude of movement of the upper limb and a decrease in the activity of daily life. After the course of treatment, the patients of the main group showed a pronounced positive dynamics of indicators, which was confi rmed by a significant decrease by 23.8 % (p < 0,05) in spasticity in the affected limb according to the MAS scale, which decreased after 6 months by 42,8 % (p < 0.01), and after 12 months by 38.0 % (p < 0,01). In patients of the control group, significantly less pronounced and unstable results were obtained and the studied indicator decreased after the course of treatment by 14,3 % (p > 0,05), after 6 months by 19,0 % (p < 0,05), and after 12 months approached the original value. The decrease in spasticity was confirmed by goniometric data, which indicated an increase in active functional use of the hand in the main group. Conclusion: The inclusion in a comprehensive rehabilitation program of patients after acute circulatory disorders with motor disorders in the form of hemiparesis with increased muscle tone by the type of spasticity of pulsed low-frequency electrostatic massage contributes to a significant decrease in the severity of spasticity, an increase in the range of motion in the affected limbs and an expansion of daily functional independence.