The effectiveness of staged reperfusion therapy in real clinical practice requires clarification. Objective: to evaluate the efficacy and safety of mechanical thromboextraction and staged reperfusion therapy with alteplase in real clinical practice. Material and methods. The study included 106 patients who were retrospectively divided into two groups: Group I underwent staged reperfusion therapy (intravenous thrombolysis with alteplase followed by aspiration thromboextraction), Group II underwent thromboaspiration only. The clinical and functional results, incidence of hemorrhagic transformation and mortality rate were compared. Results. The groups did not differ in terms of demographic data, cardiovascular risk factors or stroke severity. Group II patients were characterized by a longer delay in reperfusion therapy (225 minutes versus 180 minutes) and a lower score on the Alberta Stroke Programme Early CT score (ASPECTS; 8.8 points versus 9.3 points). There were no differences in National Institutes of Health Stroke Scale (NIHSS) scores at day 28, dynamics of NIHSS scores, Rankin scores at day 28, rates of hemorrhagic transformation or mortality. In both groups, the deceased patients were older; in Group I they suffered more frequently from atrial fibrillation, in Group II – from diabetes mellitus type 2. In addition, mortality in Group II was associated with a higher severity of early signs of cerebral infarction.Conclusion. The results of the analysis of real-life clinical practice show the comparability of the efficacy and safety of staged reperfusion therapy and isolated thromboaspiration in a “natural” selection of patients.

OBJECTIVE:To evaluate the effectiveness of the restoration of aphasic disorders in patients in the early recovery period of ischemic stroke (IS) who received complex therapy, which included speech therapy and injections of the drug Cellex. MATERIAL AND METHODS:The study included 62 right-handed patients with aphasia hospitalized in the acute period of IS in Ramenskoye Hospital, who subsequently underwent the second stage of rehabilitation in the neurological department of the Moscow regional clinical institute n.a. M.F. Vladimirskiy. Patients received rehabilitation treatment at both stages, including speech therapy sessions, and were randomized into two groups. Group 1 - 32 patients, whose treatment complex included two courses of injections of Cellex in the acute and recovery period (main group), patients of group 2 (n=30) received basic and therapy for secondary prevention of IS. To assess the condition of patients, the stroke scale of the National Institutes of Health of the United States (NIHSS), a modified Rankin scale, a screening method for patients with aphasia, and the Goodglass-Kaplan scale (GKS) were used. RESULTS:There was a statistically significant improvement in the neurological status in patients of both groups in both the acute and early recovery periods, and the shifts in patients of group 1 in both periods of IS were higher. After the course of treatment, a statistically significant regression of aphasia was noted: in patients of group 1, the score increased from 1 [0.75, 2] to 4 [3, 4] points, whereas in patients of group 2 - from [0, 1.75] to 3 [2, 3.75] points (p<0.001 between groups). Communication skills in group 1 patients increased from 0.5 [0, 1] to 4 [2, 4] points, while in group 2 patients - from 1 [0, 2] to 3 [1, 3] points (p<0.001 between groups). CONCLUSION:As a result of the study, data were obtained indicating that drug support for rehabilitation measures with Cellex, carried out in the form of two consecutive courses in the acute and early recovery periods of IS, significantly increased the effectiveness of speech therapy and accelerated the consolidation of the speech network of the brain, obviously because of activation of neuroplasticity processes.

OBJECTIVE:The dependence of result of cognitive training in patients who have suffered an ischemic stroke (IS) on the timing of their onset continues to be discussed. The aim was to study the results of cognitive rehabilitation of patients after IS during various periods after it.MATERIAL AND METHODS:140 patients were examined during complex rehabilitation in terms up to 1, 2-3, 4-6 and 7-12 months after IS, 78 of them received drug support (DS) of rehabilitation with intravenous injections of ampasse. The Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) were used to monitor the effectiveness of rehabilitation.RESULTS:In all subgroups, there was a statistically significant increase in the MoCA score after the course, but number of people with an increase in the score by 1 or more points was highest among those who started the course 3 or more months after the development of IS (p=0.015). Among those who received DS, an increase in the MoCA was noted in 87.2%, in those who did not receive it - 38.7% (p<0.001). There was no statistically significant increase in the severity of anxiety and depression after the course of treatment in any of the subgroups.CONCLUSION:The used approach of a combination of cognitive, physical rehabilitation and DS proved to be justified for achieving results during a two-week course of inpatient rehabilitation of patients both in the early and late recovery period after IS.

The review provides a brief overview of the history of the development of mirror therapy. Current data on the putative mechanisms of mirror therapy as well as the theory of mirror neurons are presented. The authors describe the implementation of the effects of mirror therapy in motor rehabilitation after stroke, including motor imagination or mental simulation of actions, strengthening of spatial attention and self-perception, activation of the ipsilateral corticospinal tract, reorganization of neuronal networks that influence the state of structurally intact but functionally inactive neurons. The authors reflected the prerequisites for the use of mirror therapy in the rehabilitation of cognitive impairment in poststroke patients. The results of current clinical studies and case reports of the use of mirror therapy for the rehabilitation of speech and non-speech cognitive disorders, and neglect syndrome after stroke are presented.

ABSTRACT INTRODUCTION. Aphasia is observed in 30-40% of patients who have suffered a stroke, and the prognosis for the restoration of speech functions in severe aphasia is unfavorable. To date, there has been no assessment of the severity of cognitive impairment in various clinical forms of aphasia. The aim is analysis of cognitive impairment in various forms of aphasia. MATERIAL AND METHODS. 572 patients with severe and moderate post-stroke aphasia, 103 with dynamic aphasia, 89 with afferent motor aphasia, 100 with efferent motor aphasia, 98 with acoustic-gnostic aphasia, 94 with acoustic-mnestic aphasia, 88 patients — with semantic aphasia. RESULTS AND DISCUSSION. The presence of violations of non-verbal cognitive domains was revealed, and the specificity of pathology was different for each form of aphasia. All examined patients showed a decrease in mental activity, fatigue, exhaustion, most pronounced with dynamic aphasia and acoustic-gnostic aphasia. Memory loss was noted in all, most pronounced in acoustic-mnestic aphasia (p < 0,001), slightly in patients with dynamic aphasia (p = 0,08). The decrease in level of attention was most pronounced in patients with acoustic–gnostic aphasia (p < 0,001), insignificant — with efferent motor aphasia (p = 0,15). Intellectual disabilities and decreased executive functions were most pronounced in dynamic aphasia and semantic aphasia (p < 0,001). Violations of praxis were characteristic of dynamic aphasia, afferent motor aphasia and efferent motor aphasia (p < 0,001), and gnosis, including visual–spatial, for acoustic-mnestic aphasia and semantic aphasia (p = 0,001–0,002). CONCLUSION. It can be assumed that rehabilitation of patients with aphasia should include, along with speech exercises, practice aimed at restoring non-speech cognitive functions, which will increase the effectiveness of rehabilitation. KEYWORDS: aphasia, cognitive impairment, executive functions, visual-spatial functions, praxis, gnosis

OBJECTIVE:To investigate the structural damage in patients with aphasia in the acute phase of ischemic stroke using X-ray computed tomography (CT) scans of the brain. MATERIAL AND METHODS:We examined 65 right-handed individuals in the acute stage of ischemic stroke in the left middle cerebral artery, including 39 men and 26 women aged 41 to 87 years. The patients were divided into two groups: those with aphasia (group 1, n=48) and those without aphasia (group 2, n=17). All participants underwent head CT scans on the first day of hospitalization and again 24 to 48 hours later, as well as CT angiography of the intracranial and brachiocephalic arteries. RESULTS:Atherothrombotic and cardioembolic pathogenic subtypes of ischemic stroke were significantly more common in group 1, while lacunar subtypes were more common in group 2 (χ2=13.608, p=0.004). Most patients had a mild to moderate stroke, but the severity and degree of disability were significantly greater in group 1. There was also a significant difference in the size of cerebral infarction (25.7±19.9 versus 3.1±3.5 cm³, p<0.001). More than 75% of patients in group 1 had lesions in speech representation areas and adjacent regions of the left cerebral cortex, and more than 90% had involvement of the speech network tracts within the infarction zone (compared to 0 and 11.8% in group 2, respectively, p<0.001). CONCLUSION:The results confirm the role of speech disorders in the level of disability after ischemic stroke. The significance of damage to both cortical representations and the conductors of the speech network is shown. This can affect the prognosis for speech function restoration, as well as allowing for personalized modeling of a rehabilitation program for these patients.

Brain–computer interfaces (BCI) are actively used in neurorehabilitation. Recent years have seen the accumulation of an extensive database of results from clinical studies conducted around the world demonstrating the efficacy of BCI in restoring motor function after stroke. The use of BCI in post-stroke cognitive impairment continues to expand. This article discusses the potential and prospects for the use of BCI in the treatment of cognitive disorders and experience of its use, presents results from clinical studies in stroke patients, evaluates the possibilities of using this technology, and describes its prospects and new areas of work addressing its effects.

The article presents a review of the literature and a description of a clinical case of osmotic demyelination syndrome manifested by pontine and extrapontine myelinolysis in a 36-year-old woman after her third surgical preterm delivery. The reasons for the development of a demyelinating lesion of the central nervous system are discussed, and clinical cases described in world literature sources are presented. An analysis of the pathogenesis of the development of this disease in women during pregnancy, childbirth, and lactation is provided. The importance of this period in a woman's life as an independent significant risk factor for the development of osmotic demyelination syndrome is discussed.

OBJECTIVE:To develop a method for assessing neurodynamic disorders in the acute period of stroke.MATERIAL AND METHODS:Sixty-three right-handed patients in the acute period of ischemic stroke (IS) were examined, including 28 patients with IS in the basin of the left middle cerebral artery (LMCA) (group 1), 19 patients with IS in the basin of the right middle cerebral artery (group 2) and 16 patients with IS in the vertebrobasilar system (group 3). The control group consisted of 37 healthy individuals. The «Tapping Test» technique developed by E.P. Ilyin was used to assess the strength of nervous processes. The mobility of nervous processes was determined by a complex sensorimotor reaction of discrimination. To assess the balance of the processes of excitation and inhibition, a complex sensorimotor reaction to a moving object was used.RESULTS:There was a significant decrease in the strength of nervous processes in the patients compared to the control group (p<0.0001), more pronounced in IS in LMCA. When checking the mobility of nervous processes in patients of groups 1 and 2, the number of errors was statistically significantly higher than in the control group (inertness of nervous processes). These indicators were the highest in patients with IS in LMCA while in patients of group 3 the lowest values, approaching the data of healthy individuals, were noted. When checking the balance of nervous processes, torpidity of reactions was noted in patients of group 1, torpidity when performing the test with a paretic hand was noted in group 2. In group 3 these indicators approach the data of healthy individuals, which reflected the approximate balance of the processes of excitation and inhibition.CONCLUSION:In the study of neurodynamic processes in patients in the acute period of IS, there was a decrease in strength, inertness, and torpidity of the mobility of nervous processes, more pronounced in the damage of the dominant hemisphere. It can be assumed that in the origin of these shifts in patients in the acute period of IS, a diaschisis plays an important role, and with left-sided localization of IS, not only the focal, but also its connective, transcallosal form.

OBJECTIVE:To study the effectiveness of brain-computer interfaces (BCI) and cognitive training using computer technologies in restoring cognitive functions in poststroke patients.MATERIAL AND METHODS:Thirty-four stroke patients (mean age 59.3±10.8 years) with stroke duration of 5.1±4.7 months, were included. To assess the effectiveness of treatment, patients before and after treatment were tested using memorization of words according to the method of Luria A.R. «10 words», the Montreal Cognitive Assessment Scale (MoCA), the Clock Drawing Test (CDT). All patients received standard rehabilitation therapy (exercise therapy, physiotherapy, sessions with a speech therapist-neuropsychologist). Patients of the first group additionally received training on the «Neurochat» complex, patients of the second group - on the «Exokist-2» complex, patients of the third group - cognitive training according to standard programs using computer technology and visual material.RESULTS:Patients of the three groups showed a significant improvement in the total MoCA score: in the 1st and 2nd groups - p<0.01, in the 3rd group - p<0.05. According to CDT, there was a significant change in the 2nd group (p=0.018). The Luria method «10 words» revealed an improvement in memory in all groups (p<0.01, p<0.05), being more pronounced in the 1st and 2nd groups.CONCLUSION:The effectiveness of BCI in restoring cognitive functions in patients after a stroke in comparison with cognitive training without BCI has been demonstrated. However, there are reasons to believe that various BCIs have a specific effect on cognitive functions and have their own target group.

In recent years, brain-computer interfaces have been widely used in neurorehabilitation, and an extensive database of results from clinical studies conducted around the world has been accumulated, demonstrating their effectiveness in restoring motor function after a stroke. Currently, their use in post-stroke cognitive impairment is expanding. This article discusses the potential and prospects for using brain-computer interfaces for the treatment of cognitive disorders, reviews the experience of using it, presents the results of clinical studies in stroke patients, evaluates the possibilities of using this technology, describes the prospects, new directions of work on studying its effects.

OBJECTIVE To assess the impact of a comprehensive support response biofeedback program on patient recovery and quality of life after a stroke during a six-month follow-up. MATERIAL AND METHODS One hundred poststroke patients were followed-up during six months after a course of treatment using a comprehensive program based on biofeedback on the support reaction, including stabilometric training «standing on the platform»; training using a power joystick for a hand on a static stabilometric platform; therapeutic gymnastic exercises for the upper shoulder girdle. RESULTS Within six months after the course of treatment, there were no statistically significant changes in the motor function of the paretic hand according to the Fugle-Meyer and Ashworth scale. In neuropsychological testing after 3 months, the indicators on MoCA, Stroop, Symbols and Numbers, Schulte, Speech Fluency, and Kohs block design tests did not show negative dynamics. There was a decrease in indicators, which did not reach the values before treatment, after 3 months according to the Digit Span test, delayed recall according to the «memorizing 10 words» test by A.R. Luria After 6 month, there were no changes on MoCA, Symbols and Numbers, Schulte and Kohs block design tests. The decline after 6 months was observed on Speech Fluency, Stroop, Digit Span tests and Delayed Recall on the 10-Word Memory Test. At the same time, there was a positive dynamic of indicators of emotional status, activity of daily life and functional activity after 3 and 6 months of follow-up, the indicator of the quality of life of patients improved after 6 months. CONCLUSION Persistent therapeutic effect of the complex program carried out for 6 months was noted in relation to motor disorders in the paretic hand. There is an improvement in the emotional state, functional status, quality of life. When assessing cognitive functions, the therapeutic effect is stable for 3 months according to most scales. At the same time, the decrease in cognitive testing indicators on individual scales, in our opinion, determines the feasibility of repeated courses of treatment in three to six months in order to prevent the progression of disorders.

Cerebral stroke is one of the leading causes of disability in the modern world. Despite the high efficacy of high-tech treatment methods, the issue of rehabilitation is extremely relevant for post-stroke patients. Much attention is paid to non-pharmacological approaches; their use in the treatment process seems to be very promising. The review presents therapeutic approaches aimed at increasing the plasticity of the brain, including rhythmic transcranial magnetic stimulation, direct current stimulation, training with a speech therapist-neuropsychologist, computerized cognitive training, biofeedback techniques for support response, electroencephalogram, high-tech approaches using virtual reality, interfaces brain-computer, art therapy, music therapy, various complexes of physical exercises.

OBJECTIVE:Was to determine the proportion of patients with ischemic stroke (IS) who achieved functional independence by the end of the hospitalization, among those who underwent systemic thrombolytic therapy (STT) with two different alteplase preparations (Actilyse and Revelisa).MATERIAL AND METHODS:An open, prospective observational non-interventional cohort study of the results of STT in patients with IS was carried out. The study included 195 patients, 123 men and 72 women aged 32 to 86 years, who received STT in the acute period of IS. Of these, 120 patients received Actilyse, 75 - Revelisa.RESULTS:Patients who achieved independence in movement (0-2 points on the modified Rankin scale (MRS)) among those who received STT with Actilyse and Revelisa, the value of the χ2 criterion was 0.014 (p=0.905), which showed that there was no statistical significance of the difference in the frequency of recovery of functional disorders on the MRS scale, in patients receiving STT with two different alteplase preparations.CONCLUSION:After STT with alteplase preparations, patients with IS experienced a significant improvement, which was expressed in a statistically significant decrease in the severity of neurological deficit and a decrease in the degree of disability. When comparing the results of STT with two different alteplase preparations, no statistically significant differences were found in terms of mortality, survival, and independence during the acute period of IS.

Ischemic stroke (IS) is the leading cause of neurological inpatient care, readmission, and long-term disability. Until now, there is no single point of view on when the second stage of medical rehabilitation after an IS should be started and the amount of the rehabilitation activities.Objective: to compare the effectiveness of the course of motor rehabilitation during the first 30–90 days and 91–180 days after IS.Patients and methods. The patients were divided into two groups: group 1 included 44 patients in whom ≤3 months passed from IS onset, and group 2–39 patients in whom >3 but <6 months have passed since the IS onset. All patients included in the study received physiotherapy exercises, simulator exercises, robotic mechanotherapy, physiotherapy, massage, speech therapy, cognitive training, and secondary IS prevention.Results and discussion. In both groups patients got a positive treatment result: a significant increase in muscle strength, gait stability, quality, and speed. The number of patients who achieved independence (≤2 points on the Rankin scale) before the start of the rehabilitation course among patients of group 1 was 9.4%, after the end of the course – 40.6%. More initially independent patients were included in the group 2 – 28.6%; after a course of rehabilitation, the proportion of independent patients increased to 35.7%.Conclusion. Rehabilitation courses are effective in patients who have had IS, both in the first three months and in the period from the 4th to the 6th month. It is advisable to conduct the second stage of medical rehabilitation earlier after a stroke.

OBJECTIVE:To assess the possibility of using the integral indicators of thrombodynamics to improve the safety of rehabilitation measures in patients in the recovery period of stroke.MATERIAL AND METHODS:A prospective study included 52 patients in the recovery period of stroke. To compare the effect of the intensity of physical activity on the change in the integral indicators of thrombodynamics in accordance with the objectives of the study, the patients were randomized into two groups. In the first group, patients received treatment, including physiotherapy, stabilometric trainings, neuropsychological tasks. Patients of the second group received complex treatment, including more intense physical activity with the use of cyclic exercises, biomechanotherapy. To assess the state of hemostasis, an integral thrombodynamics test was used, and the numerical parameters of the spatial dynamics of the growth of a fibrin clot were calculated.RESULTS:The state of compensated hypercoagulability was revealed in the majority of patients before the start of medical rehabilitation, despite taking antithrombotic therapy, which was evidence of the ineffectiveness of the therapy. At the same time, it was noted that it was its action, probably during the ongoing program of physical rehabilitation, that ensured the stability of the integral indicators of thrombodynamics and the absence of clinically significant unwanted thromboembolic complications. As a result of the analysis of the data in dynamics before and after treatment, a direct relationship was traced between the intensity of physical activity and the tendency to disturb the hemostatic balance.CONCLUSION:The intensity of physical activity during treatment undoubtedly influenced the state of hemostasis. The expediency of monitoring the dynamics of coagulation activity in patients in the recovery period of stroke has been demonstrated.

OBJECTIVE:Study of the effectiveness of the use of the drug Ampasse in the process of complex rehabilitation in patients in the early recovery period of ischemic stroke at the second (stationary) stage.MATERIAL AND METHODS:The study included 60 patients, 28 women and 32 men, aged 43 to 76 years (mean - 58.4±9.1 years), in the recovery period after suffering a stroke in the period from 1 to 12 months (on average - 4.7±3.5 months). All patients received complex rehabilitation, patients of the 1st group received additional intravenous injections of the drug Ampasse 25 mg (5.0 ml), 15 injections. Patients of the 2nd group (n 0) did not receive Ampasse. To assess cognitive functions, the following tests were used: the Montreal Cognitive Assessment Scale (MoCA), Stroop's test, subtest 9 of the Wechsler test, Koos cubes (CC), the severity of anxiety and depression was assessed, and motor recovery was assessed by the hand motor activity test (ARAT). The assessment was carried out before the start of treatment and on the 21st day.RESULTS:There was a statistically significant increase in the score on the MoCA scale, in patients of the 1st group by an average of 2 points, in the 2nd group there was no significant dynamics, a statistically significant difference was found in the proportion of patients who had an increase in the MoCA index after the course of treatment in the 1st group. compared with the 2nd (χ2 - 22.528, p<0.001). Decreased the level of rigidity according to the Stroop test in patients of the 1st group compared with the 2nd (χ2 - 8.297, p=0.004). The number of patients who showed positive dynamics in the Koos cubes test in the 1st group was statistically significantly higher (χ2- 4.344, p=0.038). A statistically significant decrease in the level of depression was revealed in patients of the 1st group. The number of patients with improved motor function of the hand was greater in the 1st group of MG (χ2 - 4.286, p<0.039).CONCLUSION:In patients in complex therapy receiving intravenous administration of the drug Ampasse at a dose of 25 mg (5.0 ml) 15 administrations, a statistically significant improvement in cognitive functions was revealed according to MoCA tests, Stroop test, Koos Cubes, when compared with the comparison group. The use of Ampasse increased the effectiveness of cognitive and motor rehabilitation in patients with post-stroke disorders.

OBJECTIVE To study the effect of a comprehensive neurorehabilitation program based on biofeedback on the support response in poststroke patients. MATERIAL AND METHODS The article presents the results of treatment of 59 patients after ischemic stroke. The program included training using a force joystick for the upper limb based on a static stabilometric platform with biofeedback according to the support reaction, training in the position of the patient standing on a stabilometric platform, exercise therapy. Patients in the control group received standard therapy. RESULTS The use of the comprehensive program contributed to a statistically significantly better therapeutic effect, increased strength, and decreased spasticity in the paretic arm, decreased anxiety and depression, and improved cognitive functions compared with standard therapy in patients in the control group. CONCLUSIONS We show the efficacy of comprehensive program based on biofeedback on the support response in the restoring period of stroke.

Objective. To compare the efficacy of restoration of gait function in patients in the early recovery period of ischemic stroke (IS) using a lower limb exoskeleton and an active-passive pedal bicycle trainer. Materials and methods. An open randomized study of 47 patients in the early recovery period of IS was undertaken. Patients in group 1 received a single rehabilitation course including exoskeleton exercises using an ExoAtlet exoskeleton; those of group 2 used a pedal trainer for active-passive training (five days per week for two weeks). Treatment results were assessed using a series of tests, including the Hauser Ambulation Index, the 10-m walking test, the Berg balance test, stabilometry, and gait biomechanics. Training courses were completed by 20 patients in group 1 and 21 in group 2. Results. Completion of training courses was followed by statistically significant increases in strength in the paretic muscles, postural stability, functional level, and walking speed in patients of both groups, though recovery was statistically significantly more marked in patients of group 1 (p < 0.05). Patients of group 1 showed a statistically significant decrease in the level of disability and an increase in the activities of daily living, changes being greater than those in group 2. Analysis of the main indicators of the statokinesiogram showed that improvements in patients of group 1 were greater, though statistically significant differences were seen only in the dynamics of the length and area of the curve in the test with the eyes open. Studies of gait biomechanics showed that gait function was altered: there was a statistically significant 2.2-fold reduction in movement speed, a 1.6-fold decrease in double stride length, an a 1.3-fold reduction in tempo compared with normal values. After completion of exercises, patients of group 1 displayed statistically significant increases in double stride length and walking speed and rate and a contraction in the locomotor cycle period. Conclusions. The study identified improvements to locomotion using instrumented rehabilitation using both an exoskeleton and an active-passive pedal trainer, though use of the exoskeleton had advantages, in that it produced statistically significantly greater recovery of strength, stability, and walking speed and symmetry over an analogous period using the trainer. A significant increase in postural stability was obtained with retention of the vertical posture.

Loss of functional activity after strokes occupies the leading position among the main causes of disability in the adult population throughout the world. Particular attention is currently paid to poststroke cognitive disorders. Construction of rehabilitation programs increasingly employs approaches based on multimodal treatments, which allows comprehensive coverage of the whole spectrum of ongoing neurological deficits in patients and provides the opportunity for more effective restoration of functional activity after stroke.