Comprehensive rehabilitation of patients with post-stroke upper limb dysfunction: a randomized controlled trial

Abstract

Introduction. The restoration of manipulative activity of the upper limb after an ischemic stroke (IS) requires the development of new technologies aimed at sensorimotor training and retraining. Reduction of spasticity of the upper limb muscles is considered as a necessary component of the program of functional restoration of the handAim. To evaluate the effectiveness and safety of the integrated use of rehabilitation technology with virtual reality and biofeedback “SENSOREHAB simulator glove” (RG) and botulinum neurotoxin type A (BTA) to restore the subject-manipulative function of the hand in comparison with an individual complex of physical therapy in the late recovery period of IS.Materials and methods. A randomized controlled trial included 76 patients, age 60.8 ± 9.2 years; the duration of the transferred IS was 8.1 ± 1.3 months. The main group (n = 42) received BTA with subsequent use of RP. The control group (n = 34) – individual physical therapy. The primary results were changes in the scores on the Fugl – Meyer scales (FMA–UL), the Action Research Arm Test (ARAT), the test with pegs and nine holes (NHPT). Secondary results: dynamics of MRCS, MAS, MoCA, HADS, Bartel index and quality of life (EuroQol-5D).Results. Improvement of the motor function of the arm in the main group according to ARAT (an increase of ≥4 points) was noted in 63.8% of cases, on the FMA–UL scale (an increase of ≥7 points in sections A–D) – in 65.5% of patients (p < 0.05), according to the NHPT test – a significant increase in the speed of execution The test was performed in 52.6% of patients. The dynamics of EQ-5D-5 (VAS) at the end of treatment reached 72.3 ± 5.7 in the main group (p = 0.03). In patients of the control group, a statistically significant improvement was noted in terms of pain and EQ-5D-5 (p < 0.05).Conclusions. A comprehensive program of medical rehabilitation of patients with post-stroke upper limb dysfunction, including the use of BTA and RG, significantly improves the recovery of fine hand movements, functional independence of patients and their quality of life.