The aim of this study was to characterize the vertical spatial orientation of the body in patients with Parkinson’s disease (PD) and healthy young (HY) controls after a single and course action of simulated microgravity in the form of “dry” immersion (DI) using computer stabilometry. After a single 45-min DI session, the trajectory parameters of the common center of pressure (CCP) in PD (n = 9) and HY (n = 12) did not change (p > 0.05), although a slight tendency for them to decrease was noted. The course of seven DI sessions (each 45 min long, within 30 days) in PD patients (n = 17) did not affect the stabilometry parameters either. The effect of a single DI session did not become more significant by the end of the DI course. The use of Romberg’s test with closing the eyes did not exercise the influence of DI on the stabilometry parameters. At the same time, after the DI session in PD patients, the score on the UPDRS-III scale decreased by 33% (p < 0.05); muscle rigidity, by 37% (p < 0.05); tremor, by 27% (p < 0.05); akinesia, by 30% (p < 0.05). Thus, there is a discrepancy between the effect of DI on clinimetrically and instrumentally measured variables, which may be due to (1) insufficient complexity of the task, (2) unaccounted influence of DI on the stabilogram trajectory separately in the frontal and sagittal planes, and (3) unaccounted factor in the development of the stabilometric signal in time.

A research experiment on the use of the ground-based microgravity model using “dry” immersion (DI) procedures as a rehabilitation measure for reducing the symptoms of Parkinson’s disease (PD) is presented in this review. It has been established that a single short-term DI procedure has a strong effect on the hemodynamics of a patient with PD, decreasing the diastolic blood pressure, improving the structure of the cardiac rhythm, and reducing the amplitude and recurrence of the summary electromyogram, as well as the degree of muscle rigidity. A treatment course consisting of seven separate DI procedures reduces muscle rigidity and the severity of motor symptoms diagnosed by the Unified Parkinson’s Disease Rating Scale pt. III (UPDRS-III), the degree of depression determined by Hamilton’s Depression Rating Scale (HDRS), and the severity of autonomic symptoms estimated by Vein’s scale. As the reaction time tests have shown, the DI course has a higher positive effect on tests with a high cognitive load than on ordinary motor tests. The obtained clinical and instrumental physiological data confirm that DI favorably affects many autonomic, affective, and cognitive parameters, as well as muscle rigidity.

The paper discusses the findings of studying neuroplastic transformations in the brain cortex owing to stroke patients therapy using soft multimodel exoskeleton complex (MEC) REGENT in comparison with activation of the cortex structures controlling locomotion in healthy people. The MEC course applied to hemiparetic patients increases walk speed; changes in the activity zones detected by functional magnetic resonance imaging (fMRI) attest to the positive trajectory of neuroplastic processes, i.e. activation in the precentral gyrus (primary motor cortex), secondary association cortex (inferior parietal lobule) on the damaged hemisphere, and right-side primary sensorimotor cortex. Analysis of the functional connectivity between the areas of interest before and after the MEC therapy elicited significant changes in the inter- and intra-hemispheric connections. This positive cortical reorganization has its origin in reduction of excitory interactions between the secondary associative areas (inferior parietal lobules in both hemispheres) and alleviation of the inhibitory interaction between the inferior parietal lobule and primary right-side sensorimotor cortex in the damaged hemisphere.

Neuromuscular electrical stimulation (NMES) of large muscle groups in patients with stable chronic heart failure (CHF) increases physical work capacity and muscle strength. The safety and efficacy of short courses of NMES in patients with decompensated CHF has not been studied. The aim of the study was to compare the impact of leg NMES, interval bicycle training, and conventional treatment on the functional capacity and quality of life in patients hospitalized with decompensation of CHF. A total of 51 patients (84.3% of men; mean age, 62.5 ± 3.3 years) hospitalized with decompensated CHF were divided into three groups: optimal pharmacological therapy (OPT) + three weeks of NMES of thigh and shin muscles starting within the first three days after admission (n = 10), OPT + three weeks of bicycle exercise training (BET) starting on the fifth to seventh day (n = 20), and the control group of OPT only (n = 21). At baseline and after the three-week symptom-limited cardiopulmonary exercise test, 6-min walk test, Duke Activity Status Index (DASI) and quality of life assessment by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were performed. Patients in the NMES and BET groups presented with similar increases in the 6-min walk distance, plus 65.0 (50.0; 112.5) and 53.0 (51.0; 78; 0) m; DASI, plus 8.6 (5.5; 11.8) and 8.0 (4.5; 9.0) points; and VO2peak, plus 1.9 (0.3; 3.2) and 2.2 (0.7; 3.2) mL/(min kg), respectively. In the control group, only the 6-min walk distance increased significantly (+21 m). The improvement in the MLHFQ score was observed in all the three groups: maximal in the BET group and minimal in the NMES group. Three weeks of leg muscle electrical stimulation and bicycle training provide similar improvement in physical capacity, daily activity, and the quality of life in patients hospitalized for severe CHF. The efficacy of NMES is comparable with low to moderate intensity interval bicycle training and well tolerated by patients.

Functional magnetic resonance imaging (fMRI) is widelyapplicable for sensorimotor cortex mapping in human. Themost challenging fMRI task for researchers is the assessment oflocomotion. The aim of our study was to design of a passivemotor fMRI paradigm for assess supraspinal control of the skillof walking in normal subjects and in patients with motor neurologicdeficit after ischemic stroke. We conducted fMRI intwo groups of human subjects: first group 19 healthy subjects(10 females and 9 males, mean age = 38 [31,5; 60] years), secondgroup 18 ischemic stroke patients in early recovery period(first 6 months) (6 females, 12 males, mean age = 55,5[45,5; 64,5] years) with severe and moderate (mean Fugl-Meyer scale score = 22 [15; 28]).The protocol consisted ofblocked-design paradigm: plantar stimulation by imitation ofslow walking vs rest. Individual and group activation patternswere analyzed using statistical package SPM5. A significantactivation (pcorrect0.05 at cluster level) in first group wasobserved in the primary and secondary sensorimotor cortex,premotor and dorsolateral prefrontal cortex, in insula. Due tolesion localization second group was subdivided into corticalsubcotrical(CS) and subcortical (S) subgroups. In CS subgroupthere was reduce of activation size, more prominent inthe affected hemisphere, whereas in S subgroup the extensionof activation regions in both hemispheres was revealed, comparingto group 1. It was demonstrated that our passive motorfMRI paradigm of walking imitation with the use of plantarload imitator Korvit can be used to localize the ensorimotorbrain areas involved in locomotion in both healthy people andpatients. Concerning stroke patients, such an approach canhelp in understanding the mechanisms of supraspinal controlof the skill walking and optimal rehabilitation strategy.

This review discusses the functioning of the motor system under normal and reduced gravity. Analysis of the experimental data led to the conclusion that all changes in the functioning of tonic muscular system are related to each other. When transiting to the state of microgravity, changes are caused by one common factor, namely a sharp decrease in the activity of support afferent input, specifically oriented to the perception and analysis of gravitational loads and firmly embedded in the mechanisms of postural synergism organization. We analyzed data obtained in studies on the activation of cortical areas of the brain during the stimulation of support afferents in order to test the hypothesis that such stimulation in both healthy subjects and patients with neurologic deficiency leads to activation of both the sensory and motor cortex involved in supraspinal control of the movement of the lower limbs, in particular when walking.

To evaluate cortical plasticity processes induced by neurorehabilitation procedures and use of multimodal exoskeleton complex 14 chronic stroke patients (mean age 57.5 ± 18.1 years, mean postsroke time 14.2 ± 9.9 months) were included. All patients trained 5 times per week for 2 weeks on multimodal exoskeleton complex and standardized physical therapy. Cortical plasticity processes were evaluated before and after trains by functional magnetic resonance imaging (fMRI) and navigated transcranial magnetic stimulation (nTMS). For fMRI we developed paradigm simulated reference load when walking. nTMS was performed for mapping leg cortical area. We evaluate rest motor threshold (RMT) and area’s squares for both tibialis anterior muscles. For clinical assessment we use a Fugl-Meyer Scale and 10 m walked test. No significant differences in clinical scales, RMT were found. Opposite directional changes in leg motor areas’ square (increase in affected hemisphere (before: 19.5 ± 22.2 mm2; after: 22 ± 17.7 mm2) and decreased in healthy hemisphere (before: 41.2 ± 24.9 mm2; after: 39.2 ± 30.8 mm2) were observed. In fMRI study the increase of activation zones in both SM1 and SMA and decrease of activation in both S2 were detected. Functional connectivity changes were founded: additional connections formation in the both hemispheres, and statistically significant interhemispheric connections between the primary motor cortex. Founded changes in cortical plasticity can be the basics of future walking improvement.

The article discusses the effect of a course of treatment with the use of multimodal complex exoskeleton (MCE) "Regent" on the reorganization of cortical locomotor zones in 14 patients with post-stroke hemiparesis, mainly atthe chronic stage of the disease. Before the course of treatment, we identified specific areas of activation in the primary sensorimotor and supplementary motor areas and the inferior parietal lobules in both affected and healthy hemispheres by means of functional MRI (fMRI) with the use of special passive sensorimotor paradigms. After the course of treatment with MCE, we observed an improvement of temporal characteristics of walking; it was accompanied by a decrease in the activation zones of inferior parietal lobules, especially in the healthy hemisphere, and by a significant increase in the activation zone of primary sensorimotor and supplementary motor areas. The analysis of the functional connectivity of studied zones before and after the course of treatment with MCE showed significant changes in intra- and interhemispheric interactions.

The space medicine data on the nature of motor disorders suggest an important role of the support inputs in the control of mammalian tonic and postural systems. Progress in functional magnetic resonance tomography (fMRT) makes it possible to perform in vivo analysis of various brain areas during stimulation of the support afferentation. Under these conditions, specific activation of the brain cortical areas was studied in 19 healthy subjects (with the mean age of 38 ± 15.13 years) and 23 patients (with the mean age of 53 ± 9.07 years) with focal CNS lesions (cortical-subcortical ischemic stroke). During scanning of subjects, the support areas of the soles of the feet were stimulated using a block design to simulate slow walking. In healthy subjects, significant activation was recorded (p < 0.05 at the cluster level) in the primary somatosensory cortex, premotor and dorsolateral prefrontal cortex, and insular lobe. In patients that had had a stroke, activation of the locomotion-controlling supraspinal systems clearly depended on the stage of the disease. In patients with a cortical-subcortical stroke, the pattern of contralateral activation of the sensorimotor locomotion predominated during motility rehabilitation.

Methods that, on the one hand, can ensure patient’s mobility and, on the other hand, activate afferent inputs are the main in the rehabilitation treatment. Recent studies have shown that plasticity is the structural basis of recovery after central nervous system lesions. Reorganization of cortical areas, increase in the efficiency of the functioning of preserved structures; and active use of alternative ascending pathways, e.g., intensification of afferent input, constitute the anatomical basis of plasticity. However, sensory correction methods, without accounting of functional condition of patients, may lead to the formation of pathological symptoms: spasticity, hyperreflexia, etc. So, the main aim is to study adequate management of the neuroplasticity process. This problem cannot be solved without modern methods of neuroimaging and brain mapping. The new approach for the study of cortical mechanisms of neuroplasticity, responsible for locomotion, was developed in the present study. This approach is an integrated use of functional magnetic resonance imaging (fMRI) and navigation transcranial magnetic stimulation (nTMS). It has been shown that vast fMRI activation area in the first and second sensorimotor areas emerges with a passive sensorimotor paradigm usage that imitates backing load during walking. The Korvit mechanical stimulator of backing zones of footsteps is used to create this paradigm. The nTMS examination used after fMRI helps to localize motor representation of muscles which control locomotion more accurately. We assume that the new approach can be used for studying the neuroplasticity process and assessing neuroplasticity changes when taking rehabilitation measures to restore and correct the walking process.

Одно из важнейших мест в системе реабилитационного лечения занимают методы, позволяющие, с одной стороны, обеспечивать мобильность пациентов независимо от степени обездвиженности, с другой, активизировать афферентные потоки. Исследования последних десятилетий показали, что структурной составляющей восстановления при поражениях центральной нервной системы (ЦНС) является пластичность головного мозга. Анатомической основой пластичности является реорганизация кортикальных отделов, увеличение эффективности функционирования сохранившихся структур и активное использование альтернативных восходящих путей, например, интенсификация афферентной информации, поступающее в ЦНС. Однако использование методов сенсорной коррекции в отрыве от функционального состояния больного может приводить к формированию патологических симптомов, таких как спастичность, повышенная рефлекторная активность и т.д. Именно поэтому приоритетной задачей является изучение возможности адекватного управления нейропластическими процессами, что невозможно без разработки оригинальных и валидных методов изучения механизмов нейропластических процессов с использованием современных высокотехнологичных средств нейровизуализации. В данном исследовании был разработан принципиально новый подход для изучения механизмов кортикальной пластичности, ответственных за локомоцию, представляющий собой комплексное применение метода функциональной магнитно-резонансной томографии (фМРТ) и метода навигационной транскраниальной магнитной стимуляции (нТМС). Показано, что при фМРТ с использованием сенсомоторной пассивной парадигмы, имитирующей опорную нагрузку при ходьбе, которая создается механическим стимулятором опорных зон стоп “Корвит”, выявляется обширная активация первичной и вторичной сенсомоторной коры, участвующей в контроле локомоции. Последующее применение нТМС в этих зонах активации позволяет более точно локализовать область моторного представительства мышц, участвующих в локомоции. Предполагается, что новый подход позволит в дальнейшем использовать его как для изучения нейропластичности, связанной с локомоцией, так и для оценки ее изменений в ходе реабилитационных мероприятий, направленных на восстановление и коррекцию ходьбы.

Results of basic studies in space medicine revealed the mechanism of motor disorders and the importance of support input in regulation of the tone and posture system of the mammals. Progress in functional magnetic resonance tomography (fMRT) enabled in vivo estimation of activity of various parts of the brain during stimulation of support afferent pathways. The goal of our study was to detect specific activation of the cortex during stimulation of support input in healthy subjects and in patients with lesions of CNS. The study included 19 healthy volunteers (mean age of 38 ± 15, 13 years) and 23 patients with cortical-subcortical ischemic stroke (mean age 53 ± 9.07); all subjects underwent fMRT. During scanning of each subject, support areas of the foot soles were stimulated to imitate slow walking using the block design. In healthy volunteers, primary somatosensory cortex, premotor and dorsolateral cortex, and insula were significantly activated (corrected <0.05 at cluster level). In patients with stroke, pattern of activation of the supraspinal systems of locomotion control clearly depended on the stage of the disease. In patients with cortical-subcortical stroke undergoing motility rehabilitation, the sensomotor locomotion module was predominantly activated as the contralateral pattern.

The lateral stiffness and electromyogram characteristics of the resting calf flexor and extensor muscles have been studied in 18 subjects during a seven-day immersion with and without mechanical stimulation of the foot support zones. It has been shown that as early as day 1 of support deprivation, the lateral stiffness steadily decreases in the m. soleus and, in contrast, drastically increases in the m. tibialis anterior. A mechanical stimulation of the foot support zones decreases the rate and degree of the changes observed in both muscles. The tight correlation of the changes in the lateral stiffness with the muscle activity suggests a significant dependence of these changes on the electromyogram characteristics at rest.