Proprioception makes an important contribution to the regulation of speed, strength, and spatial parameters of movements, determining the level of proficiency in motor skills. However, the effectiveness of various training approaches in relation to voluntary proprioceptive control of target muscles has not been sufficiently studied. In this paper, we investigated the effectiveness of three types of manipulative training: (1) fine coordination, (2) discrete muscle relaxation and (3) their combinations in relation to the accuracy of reproducing: (а) the angular deviation of the joystick from the vertical and (b) static muscle efforts during the pronation and supination of the joystick. The study involved 40 young (18–35 years old), physically active volunteers who randomly made up four groups of ten people: “Control” (lack of training), “Coordination” (training of passing an analog of a slit maze with a thin probe), “Discrete Relaxation” (training of discrete muscle relaxation of pronators and supinators of the forearm), “Combined” (combined training of maze passing and discrete relaxation). Before and after training (n = 10) we eva°luated: (1) the accuracy of reproduction of the deviation of the hand joystick from the vertical by 20°, 50°, 80° and (2) the accuracy of reproduction of isometric contraction (0, 20, 50, and 80

Aim. The paper was aimed at identifying changes in the functional state of the central nervous system after cognitive-motor training (CMT) in a virtual environment. Materials and methods. A comparative study involved 50 healthy volunteers (19 men and 31 women) aged 24 to 56 years. The functional states of the central nervous system before and after CMT in VR were determined by registering a simple visual-motor reaction. Results. Based on the average simple visual-motor reaction time (AMRT), 2 study groups were formed, namely 'pronounced mobility' (PM, AMRT 180-215 ms) and 'pronounced inertia' (PI, AMRT 218-277 ms). After CMT in VR, there was a significant decrease in the average reaction time (p = 0.002), the level of CNS activation (p = 0.005), and a decrease in the stability of the response (p = 0.0001) in the pronounced mobility group. Analysis of the efficacy of CMT in VR showed a statistically significant increase (in points) between the first and second training sessions both in the PM (p = 0.001) and PI groups (p = 0.003); however, in the PI group this increase was higher compared to the PM group (36.4 % and 21.5 %, respectively). Conclusions. The results obtained during the experiment indicate the need to take into account the typological characteristics of the nervous system when using CMT in a virtual environment.

Multiple sclerosis (MS) is a chronic autoimmune disease that limits the ability to work and lead an active lifestyle, mostly in young adults. Physical activity, along with drug therapy, is an essential part of the life of a person with MS. In the last decades, rehabilitation of MS patients has made great progress. However, the problem of compliance is still relevant. Virtual reality (VR) based rehabilitation can not only improve the quality of the training process but also increase patient compliance.Objective: to study the literature data on the effectiveness of the techniques of VR in reducing the severity of symptoms of MS and improving the quality of life.Materials and methods. A thorough literature search of the MEDLINE (Pubmed), eLibrary, and Google Schcolar databases was performed. Papers that met two criteria were included in the study: study population – patients with MS; presence of at least one comparison group (standard therapy or no therapy).Results. Based on the results of the analysis, 44 articles were selected. The efficacy of VR in reducing symptoms of MS such as fatigue, balance disturbances, risk factors for falls, mobility, apraxia, impaired hand function was described, as well as the impact on overall quality of life and its components.Conclusions. The VR rehabilitation can have its own place in the general system of physical rehabilitation and also become an effective tool to increase motivation and quality of life at all stages of rehabilitation.

Pathological synergies are a frequent consequence of cerebrovascular accidents and hinders further recovery. The existing concept of the formation of pathological synergies considers them as a compensatory strategy in response to damage to the pyramidal tract, which, due to paresis and increased muscle tone, has acquired a pathological character. Recent studies in primates have shown that the contralateral hemisphere, in particular the reticulospinal and rubrospinal tracts, may be involved in motor control of the hand. The current hypothesis presents the corticoreticulospinal and corticorubrospinal tracts as a back-up system for neuronal reorganization due to injury. This clinical case describes the role of the white matter of the contralateral hemisphere in the mechanism of formation of pathological flexion synergy, based on data from the analysis of movements and neuroimaging.

Cortical asymmetry is one of the fundamental but not fully understood feature of the brain. Special attention in modern research is paid to manual asymmetry, studied using biomechanical and neurophysiological analysis. To determine the kinematic differences between the dominant and non-dominant hands in healthy volunteers when performing a simple functional automated task-oriented movement. The study included 10 healthy volunteers aged 24 to 42 years, 4 women, 6 men. Biomechanical assessment was carried out using the video motion analysis system “Biosoft-3D.” As a movement paradigm was chosen reaching, grasping a glass from the table and drinking imitation, performed alternately with the right (dominant) and left (non-dominant) hand. Tatistically significant differences of angles and angular velocities were observed on short segments of the trajectory of movement in the shoulder and wrist joints. The analysis of the angular velocity variability showed that the variability in the left hand was significantly higher than in the right (p < 0.05). The data obtained allow us to conclude that, in general, the movements of the right (dominant) and left (non-dominant) hand when performing a task-oriented movement differ only during short parts of movement and have a non-linear character.

Narushenie ravnovesiya v pozhilom vozraste yavlyaetsya ostroj problemoj v sovremennoj medicine i chasto privodit k ser'eznym posledstviyam, snizhayushchim kachestvo zhizni. K osnovnym prichinam takogo narusheniya otnosyat zamedlenie skorosti reakcii i vestibulo-atakticheskij sindrom. Dlya korrekcii narushenij ravnovesiya u dannoj kategorii bol'nyh naibol'shij interes predstavlyaet tekhnologiya virtual'noj real'nosti, v chastnosti s kombinirovannoj trenirovkoj skorosti reakcii i ravnovesiya. Cel'yu issledovaniya bylo izuchit' vliyanie kombinirovannyh trenirovok v virtual'noj srede na postural'nye i psihofiziologicheskie pokazateli u pozhilyh pacientov s hronicheskoj ishemiej golovnogo mozga (HIGM). V issledovanie bylo vklyucheno 24 pacienta s diagnozom HIGM (mediana vozrasta sostavila 66 let). Vse pacienty prohodili trenirovku v virtual'noj real'nosti. Do i posle trenirovki pacientam provodili psihofiziologicheskoe i stabilometricheskoe testirovanie, a takzhe klinicheskuyu ocenku. Vyyavleno, chto u pacientov znachimo uluchshaetsya funkciya ravnovesiya po shkale balansa Berg do 50 [45; 54], posle 53 [52; 55] (p < 0,05), a takzhe izmenyaetsya strategiya podderzhaniya ravnovesiya po rezul'tatam stabilometrii, chto podtverzhdeno umen'sheniem koefficienta Romberga posle reabilitacii: do 266 [199,5; 478,5], posle 221 [149,25; 404] (p < 0,05). Sredi psihofiziologicheskih pokazatelej naibolee znachimye izmeneniya nablyudali v uluchshenii prostoj sluho-motornoj reakcii: do 210 [174,25; 245,5], posle 180,5 [170,5; 208] (p < 0,05). Takim obrazom, kombinirovannaya trenirovka skorosti reakcii i ravnovesiya v virtual'noj srede yavlyaetsya effektivnym metodom reabilitacii pacientov pozhilogo vozrasta s narusheniem funkcii ravnovesiya.

Balance impairment at advanced age is a serious medical problem that often has significant implications and affects the quality of the patient's life. Among the underlying causes are overall slowness of motor response and vestibular syndrome. Virtual reality exergames, including reaction and balance training, hold promise for managing balance dysfunction. The aim of this study was to investigate the effects of a combination rehabilitation program containing elements of virtual reality exergame on the postural and psychophysiological parameters of elderly patients with small vascular disease The study was conducted in 24 patients with small vascular disease (median age: 66 years). All patients underwent a virtual reality rehabilitation program. Psychophysiological, postural and clinical evaluations were performed at baseline and after the program was completed. Balance function measured on the Berg scale improved significantly and was 53 [52; 55] after the training program vs 50 [45; 54] at baseline (p < 0.05). The strategy of balance control also changed: the Romberg ratio was 266 [199.5; 478.5] before rehabilitation and 221 [149.25; 404] after the program was completed (p < 0.05). The most pronounced changes in the measured psychophysiological parameters occurred in the simple audiomotor reaction, which improved from 210 [174.25; 245.5] at baseline to 180.5 [170.5; 208] after rehabilitation (p < 0.05). Thus, the combination balance and reaction virtual reality training is an effective rehabilitation method for advanced-age patients with balance impairment.

OBJECTIVE:To perform linguistic and cultural adaptation of the Fugl-Meyer Assessment of Physical Performance.MATERIALS AND METHODS:The study for assessment of psychometric properties included 53 post-stroke patients with neurological deficit presented by hemiparesis of different severity. The patients were assessed twice: at admission and after 14 days of treatment and rehabilitation procedures. The Russian version of the Fugl-Meyer Assessment of Physical Performance was developed with consideration of language and cultural characteristics.RESULTS AND CONCLUSION:Results of assessment of psychometric properties of the Russian-language version show its high validity, reliability and sensitivity. The developed Russian-language version of Fugl-Meyer Assessment of Physical Performance is recommended for using by neurologists and rehabilitation specialists both in everyday clinical practice and in clinical studies of patients with post-stroke paresis. The results obtained in the study show necessity for pre-training of specialists who perform assessment of patients with post-stroke paresis using the Fugl-Meyer Assessment of Physical Performance.

Surface electromyography (EMG) has long since entered the routine of both clinicians and researchers, providing simple and objective quantitative assessment of the function of the muscles and peripheral nervous system. The vast majority of modern high-tech rehabilitation and assistive technologies use surface EMG as a feedback source or exoskeleton drive controller. For all years of its use, surface EMG has not become a versatile method, having encountered a number of obstacles, both in science and in clinical practice. However, the development of technologies, combined use together with other methods, and large number of studies aimed at improving the method has allowed surface EMG to become an indispensable tool in biomechanical analysis of movements and practical rehabilitation. This review describes the main advantages and disadvantages, research results, and clinical use of surface EMG.

Introduction: Neurology is arguably one of the most difficult subjects to teach and study in the medical curriculum. Educational games (EG) may be a valid option to enhance motivation in neurology residents. Methods: We developed an educational board game (Neuropoly) to assist in teaching neurology. We present here an overview of the game, as well as the results of a pilot study aimed at determining: (a) the efficacy of the game in teaching certain neurological concepts; and (b) student compliance and satisfaction with the EG. Results: The pre- and post-play questionnaire scores differed significantly (3.2 ± 1.7 vs. 7.8 ± 1.6, p < 0.001). Our group of residents, showing an overwhelmingly positive response, very well received the game. The questions were rated as above average regarding difficulty. Conclusion: The "Neuropoly" educational board game has been shown to be interesting, efficient, and motivational among first- and second-year neurology residents. Novel educational methods for complex medical disciplines should be developed, with board games being a viable and inexpensive approach.

Multiple sclerosis is a common cause of disability among young and middle-aged people. Despite the modern possibilities of diagnostics and therapy, over time, the disease acquires a secondary progressive character. Rehabilitation of patients at all stages of the disease plays an important role in improving well-being, improving the quality of life, adapting the patient and restoring motor skills. However, there is currently no clear recommendation for the application of specific techniques in each case. The aim of this work was to analyze the available methods of rehabilitation therapy, to highlight the most used and promising ones. Due to the progressive course of the disease, the benefits of rehabilitation measures are usually higher at the initial stages. Nevertheless, nowadays there is a large number of works devoted to rehabilitation measures in patients with moderate and high levels of disability. It has been shown that both inpatient and outpatient rehabilitation has a positive effect on the quality of life and improvement of clinical indicators. Our review describes the main techniques with recommendations for the scheme of application. A comprehensive assessment of the patient's health status, a multidisciplinary team and a personalized approach increase the quality and effectiveness of rehabilitation measures. We also describe our own experience in the treatment of spasticity in patients with a secondary progressive multiple sclerosis.

The key factor promoting post-stroke gait disturbances is motor impairment of the ankle joint (AJ) which results in pathological synergies. Robotic devices used for gait training are equipped with hip and knee joint actuators. However, there is no consensus in the literature on their effect on AJ movements. The aim of this study was to investigate the effect of robot-assisted gait training on AJ movements in patients with post-stroke paresis. The study recruited 22 hemispheric stroke survivors. They motor function was assessed using clinical scales and motion capture analysis. All patients received 11 robot-assisted gait training session. After rehabilitation, the total score on the Fugl-Meyer Assessment scale increased from 146.5 to 152 points (p < 0.05); for the lower limb, the score increased from 18 to 20.5 points (p < 0.05). The muscle tone of ankle extensors decreased from 2.5 to 2.0 points on the modified Ashworth scale (p < 0.05). The duration of the stance phase increased from 28.0 to 33.5% relative to the total gait cycle (GC). The main difference in the GC structure before and after rehabilitation is the presence of 3 GC parts instead of 5, suggesting consolidation of patients’ goniograms at 1-61% of GC. Comparison of joint angles before and after rehabilitation revealed that only the interquartile ranges (IR) were different (р < 0.05). The authors conclude that robot-assisted training with knee and hip joint actuators indirectly affects the kinematic parameters of AJ by promoting a shift towards the average gait kinematics.

Обоснование. Степень двигательной активности человека зачастую является определяющим фактором здоровья и долголетия человека. Малоподвижный образ жизни служит предпосылкой к развитию многих заболеваний и негативно сказывается на гармоничном физическом развитии человека. Результатом низкой физической подготовленности является снижение координации движений и функции сохранения равновесия, что в свою очередь может служить причиной падений и травм. На сегодняшний день, у здоровых людей трудоспособного возраста и подростков не всегда представляется возможным организовать мероприятия физкультурного характера, однако решением данного вопроса могут послужить современные технологии реабилитации. Цель — анализ эффективности комплекса физических упражнений, выполняемого в виртуальной среде, с целью тренировки функции сохранения равновесия у людей с низкой физической подготовленностью. Методы. В экспериментальной группе выполнялся комплекс физических упражнений в виртуальной среде с дополнительными педагогическими условиями, обеспечивающими нестабильную опору, а добровольцы контрольной группы продолжали двухнедельные занятия в рамках комплексного моторного обучения. Результаты. В исследовании приняло участие 20 добровольцев женского пола (в возрасте от 16 до 17 лет), которые были разделены на две равные, сопоставимые по возрасту ( р > 0,05) группы. Cтатистический анализ данных, полученных по окончании курса тренировок, показал отсутствие имевшегося до начала исследования достоверного различия между экспериментальной и контрольной группами в показателях максимального отклонения туловища в инструментальном тесте Ромберга ( p = 0,11), при стойке на мысках с закрытыми глазами ( p = 0,24), а также по времени устойчивости в пробе Бондаревского ( p = 0,07). Заключение. Выполнение физических упражнений с визуальной поддержкой биологической обратной связи в системе виртуальной реальности может содействовать интенсификации обучающего процесса, оказывать благоприятное воздействие на профилактику малоподвижного образа жизни, а также способствовать тренировке функции равновесия как одной из важнейших способностей человека, определяющих его двигательные возможности.

Due to the slowing of the neurodynamic and cognitive processes, as well as changes in the musculoskeletal system that accompany aging, attention, reaction, and movement coordination are impaired in elderly patients. Decreased overall brain adaptability leads to an increased risk of falls and disability, thus reducing the age of active aging. According to the World Health Organization, 37.3 million falls occur annually that are not fatal but have serious consequences requiring medical attention. These falls are most common among people over the age of 65 years. An objective assessment of psychophysiological characteristics identified a correlation between the duration of simple and complex reactions and the risk of falls and served as a tool for evaluating the effectiveness of balance retraining. Studies have shown that cognitive-motor training improves postural stability and functional performance in daily life. This type of training is widely used to rehabilitate patients with balance disorders, and virtual reality systems are increasingly being used in its implementation. There is a theory that the virtual environment can improve responses to rapid environmental changes, as well as modulate various characteristics of attention, spatiotemporal memory, and planning, which favorably affects postural function. This review describes the changes in psychophysiological parameters in the elderly, as well as balance retraining techniques using cognitive-motor training, including the use of virtual reality technology.

Various bone grafting methods are applied to eliminate horizontal atrophy of the jaws. However, problem complexity brings about ongoing research and development of new ways to achieve the predicted stable and long-term results of implantological treatment. The aim of the study was to evaluate the results of the developed method for bone grafting, a modified two-stage split technique for controlled ridge augmentation in horizontally atrophic posterior mandible, using radiological analysis data. Materials and Methods. The study group included 18 patients with horizontally atrophic posterior mandible. According to cone beam computed tomography, 39 jaw segments were assessed before plastic surgery and after applying the two-stage split-crest technique for controlled ridge augmentation. The alveolar ridge width was estimated in the area of its top and at a distance of 1, 3, 5 mm from it using the vector of future implant position and taking into account the angle of inclination of the atrophic region of the mandible. Results. When analyzing edentulous areas in the posterior mandible before treatment, there was rather a large angle of lingual inclination of the alveolar ridge. After 6 months, the average increase in bone tissue width in the region of the alveolar ridge top was 82%, it was 50.6% at a height of 1 mm from the top of the crest, 58.8% at 3 mm height, 46.7% at 5 mm (p≤0.05). Certain patterns of bone tissue growth were revealed depending on the structure of the reconstructed area. The most significant results were obtained in the molar segments of the mandible. Conclusion. The developed modified two-stage split technique for alveolar ridge augmentation allows achieving the required volume of bone tissue in the posterior mandible for successful implant treatment.

Spasticity after stroke is a factor that causes disability and restricts activities of daily living, and represents a problem for both doctors and patients relatives. At the present time, the modified Ashworth scale (MAS) is a useful method of assessing increased muscle tone in patients after a cerebrovascular incident. The aim of the work is the linguistic and cultural adaptation of the MAS, with subsequent evaluation of its psychometric properties. Materials and methods. The study included 50 patients. The validation procedure consisted of linguistic and cultural adaptation and evaluation of the psychometric properties of the Russian language version of the MAS. Test-retest was used to examine reliability (calculating Spearmans rank correlation coefficient) and Cohens kappa coefficient was used to evaluate inter-rater agreement. Criterion validity was assessed by comparing the MAS results with the Spasticity Scale score of the Research Centre of Neurology. Sensitivity was measured using Wilcoxon nonparametric test, which reflects the statistical significance of intertest differences before and after rehabilitation measures. Results. Test-retest analysis showed a significant correlation (0.87) between reassessment results. Inter-rater reliability was average (0.56), which confirms the scales subjectivity and proves that patient assessment over time should be performed by the same investigator whenever possible. The correlation coefficient between the MAS and the Spasticity Scale of the Research Centre of Neurology was 0.79. Statistically significant differences were found when patients were reassessed after rehabilitation treatment (p0.0001). Conclusion. The Russian version of the MAS is a valid, reliable, and sensitive instrument, which can be recommended for use in clinical practice, both for the initial assessment of spasticity and for monitoring the effect of treatment.