Актуальность: хирургическая реваскуляризация миокарда остается наиболее эффективной процедурой лечения ИБС у пожилых пациентов, поскольку позволяет устранить симптомы заболевания, увеличить отдаленную выживаемость и улучшить качество жизни больных. Коронарное шунтирование (КШ) занимает ведущее место в ее лечении. Однако вопросы послеоперационного качества жизни и состояния здоровья остаются очень дискутабельными в научных кругах. И, несмотря на многочисленные исследования и наблюдения, прогностический эффект кардиореабилитации все еще обсуждается. Цель: проанализировать отдаленные результаты у пациентов старше 65 лет с ИБС (за год наблюдения), получивших комплексную программу кардиореабилитации после выполнения операции шунтирования коронарных артерий по сравнению с группой пациентов, по той или иной причине, не проходившие реабилитацию или получившие ее не в полном объеме. Материалы и методы: было проведено одноцентровое когортное проспективное исследование (в среднем 12±3 месяца) в общей группе (n=130) пациентов - изучения влияния полноценных этапов кардиореабилитации на качество жизни пациентов ИБС пожилого возраста, перенесших АКШ. В ходе исследования большинство пациентов принимали назначенные лечащим врачом антиангинальные и гипотензивные препараты, аспирин, статины. Наблюдение за послеоперационным течением проводилось как путем фиксации изменений при повторных визитах, так и с помощью периодического общения по телефону. При этом обращалось внимание на переносимость физической повседневной активности (проводился тест с 6-минутной ходьбой), компенсация АД, динамический контроль ЭКГ, ЭХО КГ с определением динамики фракции выброса и дисфункции левого желудочка, фиксировались все имевшие место в период наблюдения сосудистые события и катастрофы. Результаты и выводы: на основании результатов проведенного исследования выявлен ряд прогностически неблагоприятных факторов у пациентов пожилого возраста после КШ, такие как - многососудистое поражение коронарных артерий, ожирение, курение, хроническая сердечная недостаточность, сахарный диабет, неконтролируемая артериальная гипертензия. Но одним из основных факторов - выявлено отсутствие этапов кардиореабилитации. По результатам наблюдения пациентов после получения полноценных этапов кардиореабилитации показало большее улучшение качества жизни, более поздние сроки возникновения эпизодов стенокардии и развития хронической сердечной недостаточности, а также более высокую приверженность пациентов к базисной терапии ИБС. Необходимы дальнейшие исследования и поиски возможностей в перспективе для более широкого и раннего внедрения и доступности этапов полноценной кардиореабилитации у пациентов перенесших операцию шунтирования коронарных артерий. Relevance: Surgical myocardial revascularization remains the most effective procedure for the treatment of coronary heart disease in elderly patients, as it allows to eliminate the symptoms of the disease, increases long-term survival, and improves patients' quality of life. Coronary bypass surgery grafting (CABG) occupies a leading place in the treatment of coronary heart disease. However, the issues of patients' postoperative quality of life and health condition remain very controversial. Objective: to analyze long-term results in patients over 65 years of age with coronary artery disease (during the year of follow-up) who received a comprehensive cardiac rehabilitation program after performing coronary artery bypass surgery compared to a group of patients who did not undergo rehabilitation or did not receive it in full capacity. Materials and methods: a linear single-centered cohort study (on average 12±3 months) was conducted in a general group (n=130) of patients to study the effect of cardio rehabilitation on the quality of life of elderly patients with coronary heart disease who underwent CABG. During the study, most patients took antianginal and antihypertensive medications, aspirin, and statins that were prescribed by the attending physician. Observation of the postoperative course was carried out both by recording changes during repeated visits, and by periodic phone calls. At the same time, the tolerability to everyday physical activity (a 6-minute walking test was performed), blood pressure compensation, dynamic ECG monitoring, and echocardiography with the determination of the changes in the ejection fraction and left ventricular dysfunction, all vascular events, and failures that took place during the observation period were recorded. Results and conclusions: based on the results of the study, several unfavorable factors were identified in elderly patients after CABG, such as multivessel coronary artery disease, obesity, smoking, chronic heart failure, diabetes mellitus, and uncontrolled hypertension. But one of the main factors is the absence of cardiac rehabilitation. According to the results of observation, after passing all stages of cardio rehabilitation, patients showed a significant improvement in the quality of life, later onset of episodes of angina pectoris and the development of chronic heart failure, as well as a higher adherence of patients to basic therapy for coronary artery disease. Further studies are needed for wider implementation and accessibility of cardio rehabilitation in patients who have undergone coronary artery bypass surgery. Өзектілігі: әлбетте, миокардты хирургиялық реваскуляризациялау егде жастағы адамдарда ЖИА емдеуде тиімді процедура болып саналады, өйткені бұл аурудың белгілерін жоюға мүмкіндік береді, өмір жасын ұзартады және науқастың өмір сапасын жақсартады. Оны емдеуде тәждік артерияларды шунттау (ТӘШ) жетекші орын алады. Дегенмен, отадан кейінгі өмір сапасы мен денсаулық жағдайы ғылыми ортада жоғары пікірталас тудырады. Мақсаты: 65 жастан асқан ЖИА - мен ауыратын (бір жыл бойы бақылауда болған) коронарлық артерияны шунттау операциясынан кейін кардиохирургиялық оңалтудың кешенді бағдарламасынан өткен пациенттермен, белгілі себептермен реабилитациядан өтпеген немесе оны толық өтпеген пациенттердің ұзақ мерзімді нәтижелерді талдау. Құрал-жабдықтар және әдістер: ЖИА - мен ауыратын егде жастағы науқастарға Аортатәждік шунттау (АТШ) операциясы жасалғаннан кейінгі кардиооңалтудың толық кезеңдерінің науқастың өмір сапасына әсерін зерттеу үшін (орташа 12±3 ай) жалпы топта (n=130) науқас - бір орталықты когортты проспективті зерттеу жүргізілді. Зерттеу барысында науқастардың басым көпшілігі емдеуші – дәрігері тағайындаған антиангинальды және гипотензивты препараттарды, аспирин, статиндерді қабылдаған. Операциядан кейінгі бақылау қайта тексеруге келгенде немесе телефон арқылы өзгерістерді белгілеумен жүзеге асырылды. Күнделікті физикалық белсенділікке аса назар аударылды (6 - минут жаяу жүрумен тест жасалынды), АҚ компенсациясы, ЭКГ динамикалық мониторингі, сол жақ қарыншаның лақтыру фракциясы мен дисфункциясының динамикасын анықтай отырып, ЭХО КГ, бақылау кезеңінде болған барлық тамырлық өзгерістер мен апаттар тіркелді. Нәтижелер мен қорытындылар: Жасалған зерттеу нәтижелеріне сүйенсек ТАШ – тан кейінгі егде жастағы науқастарда болжамды жағымсыз факторлар қатары анықталды, оның ішінде - көп тамырлы коронарлық артерияның зақымдануы, семіздік, темекі шегу, созылмалы жүрек жеткіліксіздігі, қант диабеті, бақыланбайтын артериялық гипертензия. Бірақ, негізгі факторларың бірі – кардиооңалту кезеңдерінің болмауы анықталды. Ал кардиооңалтудың барлық кезеңдерін толығымен өткен науқастардың нәтижесі – өмір сапасы жақсарған, стенокардия эпизодтарының және созылмалы жүрек жеткіліксіздігі дамуының кешеуілдеуі,сондай-ақ науқастардың ЖИА - ның базистік терапиясын жоғары ұстануы. Тәждік артерияны шунттау отасы жасалған науқастарды оңалту кезеңдері қолжетімді болу үшін және кеңінен қолданысқа енгізу үшін зерттеулер мен ізденістер керек.

The aim was to examine the relationship between the ability to learn new motor skills and preference to the right or left front paw when performing manipulation movements in rats. As a new skill used the Morris water maze, in which the animals are initially trained to detect platform hidden under water at the swim of the sector of the opposite platform, and then when sailing from sectors on the left or the right of the platform. Preference paw was determined by using the taking of animal food from a narrow horizontal tube and, accordingly, the rats were divided into left-handedness and right-handedness. We found that when changing the place of launch, that is the first voyage from the left or right of the sector, are right-handed, unlike left-handed, spent significantly more time to find the platform.

The aim of the present work was to study the interaction between the ability to learn a new motor skill and the preference for the right or left forelimb on performing manipulatory movements in rats. The new skill was the Morris water test, in which the animals were initially trained to find a platform hidden beneath the water by swimming from the sector opposite the platform and then by swimming from sectors located to the left and right of the platform. Forelimb preference was identified in terms of the animal’s grasping food from a narrow horizontal tube, such that the rats were divided into left-handed and right-handed animals. Our findings showed that a change in the start position for the first episodes of swimming from the left or right sector significantly increased the platform-finding time in right-handed rats, as compared with left-handed.

Motor evoked potentials (MEPs) in the right first dorsal interosseous (FDI) muscle elicited by transcranial magnetic stimulation of left motor cortex were assessed in ten healthy subjects during maintenance of a fixed FDI contraction level. Subjects maintained an integrated EMG (IEMG) level with visual feedback and reproduced this level by memory afterwards in the following tasks: stationary FDI muscle contraction at the level of 40 ± 5 % of its maximum voluntary contraction (MVC; 40 % task), at the level of 20 ± 5 % MVC (20 % task), and also when 20 % MVC was preceded by either no contraction (0–20 task), by stronger muscle contraction (40–20 task) or by no contraction with a previous strong contraction (40–0–20 task). The results show that the IEMG level was within the prescribed limits when 20 and 40 % stationary tasks were executed with and without visual feedback. In 0–20, 40–20, and 40–0–20 tasks, 20 % IEMG level was precisely controlled in the presence of visual feedback, but without visual feedback the IEMG and force during 20 % IEMG maintenance were significantly higher in the 40–0–20 task than those in 0–20 and 40–20 tasks. That is, without visual feedback, there were significant variations in muscle activity due to different prehistory of contraction. In stationary tasks, MEP amplitudes in 40 % task were higher than in 20 % task. MEPs did not differ significantly during maintenance of the 20 % level in tasks with different prehistory of muscle contraction with and without visual feedback. Thus, in spite of variations in muscle background activity due to different prehistory of contraction MEPs did not vary significantly. This dissociation suggests that the voluntary maintenance of IEMG level is determined not only by cortical mechanisms, as reflected by corticospinal excitability, but also by lower levels of CNS, where afferent signals and influences from other brain structures and spinal cord are convergent.

Early stage Parkinson's disease (PD) shares certain symptoms with essential tremor (ET), which makes it difficult to differentiate between the two. We analyzed cyclical body bends to find kinematic parameters that are capable of differentiating among PD, ET and normal control (NC) subjects. A linear discriminant analysis of the joint angles showed a reliable distinction between NC and the two groups of patients, while differentiating reasonably well between PD and ET. PD patients showed difficulty performing hip segment rotation around the vertical axis, whereas ET patients demonstrated enlarged torso sway in the frontal plane. These findings suggest that kinematic parameters of body movement in the standing position are sensitive enough to serve as subclinical marks in the early diagnosis of PD and ET.

Результаты исследования показывают, что наличие генетической эпилепсии существенно влияет на предпочтение правой или левой конечности в процессе обучения пищедобывательному навыку у крыс. При этом такое влияние зависит от характера эпилепсии: при судорожной эпилепсии, вызываемой звуковыми стимулами, преобладает предпочтение правой конечности, т.е. доминирует активность левого полушария. В то же время при absence-эпилепсии преобладает предпочтение левой конечности, т.е. активность правого полушария. Среди крыс с судорожной эпилепсией преимущественно стволового происхождения (главным образом, крыс линии Wistar) доминируют «правши», тогда как в группе крыс линии WAG/Rij с «неконвульсивной» («absence») эпилепсией кортико-таламического генеза преобладают «левши». Предполагается, что межполушарная асимметрия при эпилепсии связана с соответствующей патологией: доминирование левого полушария («правшество») – с наличием судорожной патологии стволового генеза, а доминирование правого полушария («левшество») – с таламо-кортикальной патологией.

We studied voluntary control of integrated electromyogram (IEMG) in the range of 20 +/- 5% and 40 +/- 5% of the IEMG of m. abductor pollicis brevis during its maximum voluntary contraction with and without visual feedback. Healthy subjects performed IEMG control with visual feedback in 5 trials; IEMG control with visual feedback in 5 trials for 5 days, and the reproduction of memorized IEMG value without visual feedback after 5 trials of IEMG under the visual control. The accuracy of IEMG control was estimated by the following parameters: time of IEMG being out of the required 10% range (ERROR); IEMG variability (VARIABILITY), and the bias of IEMG mean level (BIAS) during 30-sec trials. The IEMG control in the range of 20 +/- 5% with visual feedback improved in all subjects over the course of 5 trials. Within 5-day training, ERROR and VARIABILITY reduced on the first day only; during the last 4 days there was no accuracy increase. ERROR increased more than twice when the 20% IEMG level was reproduced without vision. The IEMG control in the range of 40 +/- 5% improved neither during 5 trials, nor during 5 days of training with visual feedback. ERROR increased for about 1.5 times when the 40% IEMG level was reproduced without vision. It was concluded that the motor system, particularly the motor cortex, could control the given level of muscle activity using the visual feedback.

The review is devoted to analysis of the basic links of motor behavior control systems: sensorimotor cortex, cerebellum, a red nucleus and striatum. The organization and communications of these structures and their participation in learning and memory processes are described. The synaptic neurotransmitter and nonsynaptic neuromodulatory systems innervating these structures are also described. Hierarchical synaptic networks are formed by GABA and glutamatergic systems. The nonsynaptic dopaminergic system innervates both of these structures, but carries out a modulatory function. The mesocorticolimbic dopaminergic system induces an emotional and motivational state - processes of reinforcement, and participates in realization of purposeful behavior. The nigrostriatal dopaminergic system, through triggering an endocellular signal and the processes ofphosphorylation and dephosphorylation modulates activity ofGABA and glutamatergic receptors ofdorsal striatum spiny neurons and adapted thalamocortical networks.

Patients with the initial stage of Parkinson disease (PD) and matched controls performed repetitive bendings and turnings in standing position. Tasks included trunk movements in each of the anatomical planes: sagittal, frontal and axial. Electromagnetic system Flock of Birds was used for movement registration. Sensors were fixed at different segments of subject's body. Joint angles in the ankle, hip and torso as well as coordinates of the center of pressure served as output parameters. The amplitudes of joint angles were found to be lower in PD patients. Performance of the axial rotation revealed most pronounced differences. Thus, the amplitudes of joint angles of trunk movements in different anatomical planes reliably discriminate between PD patients and healthy subjects.

The mechanisms of reorganization of motor systems at the poststroke patients after rehabilitation were studied using the method functional magnetic resonance imaging (fMRI). At patients after standard rehabilitation therapy, irrespective of localization of stroke, the increase in intensity of the basic activity zones in sensomotor areas and in the field of a hemisphere of a cerebellum as for paretic, so for a healthy hand was revealed. At patients after EMG biofeedback training of the precision grip the reorganization of functional motor system consists in more significant increase of intensity of activation of the basic zones only in lesioned hemisphere; expressiveness of these changes did not depend on localization of stroke. The degree of restoration of movements of hand after EMG biofeedback training was authentically above, than after a course of standard rehabilitation therapy. Thus, fMRI and the clinical analysis have shown that EMG biofeedback training of the precision grip have the goal-directed and effective influence upon processes of functional reorganization of motor systems.

There are a number of studies concerning difference of postural control following left or right hemisphere lesions. Few studies, however, compare the role of the right and left hemisphere in learning new postural tasks. This study aimed to address this question. Twenty patients with hemiparesis after ischemic stroke in the middle cerebral artery territory (11 with a right and 9 with a left hemispheric lesion) were investigated. All subjects were trained using two different tasks during ten training sessions. In both tasks, the subjects stood on a force platform and were taught to change the position of the center of pressure (COP) presented as a cursor on a monitor screen in front of the patient. The subjects were instructed to align the COP with the target and then move the target by shifting the COP in the indicated direction. In the “Balls” task, the position of the target (a ball) varied randomly, so the subject had to learn a general strategy of voluntary COP control. In “Bricks”, the subject always had to move the target in a single direction (downward) from the top to the bottom of the screen, so that a precise postural coordination had to be learned. The number of correctly performed trials for a session was scored. The task performance and its rate were analyzed and compared with respect to the lesion lateralization between two patient groups. The voluntary control of the COP position and learning course were initially impaired in all groups of patients in both tasks. In “Balls”, there were no differences between the two groups of patients. In contrast, in “Bricks”, there was a greater initial deficit in patients with right hemisphere lesions, while the rate of postural learning and the final performance level did not differ between the groups. With a lower initial deficit and similar rate of learning, the maximal level of the task performance was reached earlier (on the 5th day of training) in patients with left hemisphere lesions. This group stopped improving its performance during follow-up training. The results suggest that the motor structures of the right hemisphere are more involved in the precise control of COP trajectory, but not in learning. There is no difference between hemispheres in the initial performance and learning of the general strategy of voluntary COP control. Possibly, the control of specific COP trajectory needs more sensory feedback that is associated with greater involvement of the right hemisphere. This might be a reason for the greater initial impairment of this task after lesions in the right hemisphere.

Using the transcranial magnetic stimulation (TMS) of motor cortex we examined changes in the motor evoked potential (MEP) during natural bimanual unloading, during lifting of an equivalent weight by the contralateral arm while the ipsilateral forearm was held stationary (CONTRA) and during practice of unnatural unloading. During natural unloading, MEP amplitude decreased proportionally to the muscle activity. In CONTRA task MEP amplitude decreased, but the muscle activity was not changed. It suggests that the motor cortex activity related to the "postural" arm was inhibited by the contralateral motor cortex related to the "lifting" arm. This inhibition was diminished during the unloading task. When learning the unnatural unloading, the muscle activity decreased significantly with insignificant changes of MEP amplitude. Active role of the motor cortex during learning of the new task might be related to the reduction of the contralateral inhibition. This suggestion is supported by the observation that MEP amplitude decreased stronger than muscle activity in the first learning session similar to that in CONTRA task. MEP amplitude and background activity of the muscle proportionally decreased in the last learning trial. The results show that motor cortex activity in natural and unnatural unloading task might be related to the reduction of the interhemispheric inhibition.

The concentration of dophamine and its derivates is known to correlate with the degree of handedness in manipulative movements in rodents. In this work we studied a possibility to changing handedness in rats by injection of a dopamine agonist into the nucleus accumbens. Retrieving food from a horizontal tube was used to determine the limb preference (10 food retrievals by the preferred limb). Then apomorphine was injected into the n. accumbens ipsilateral to the preferred limb in the Course of 7 days. The same volume of buffer solution was injected into the contralateral n. accumbens. Just after the last in injection the limb preference was tested. It was shown that the chronic injection of the non-specific agonist of dophamine receptors significantly changed the limb preference.

Several studies on mice have demonstrated a correlation between the concentrations of dopamine and its metabolites in the nucleus accumbens and asymmetry in forelimb preference. Dopamine concentrations were greater in the nucleus accumbens ipsilateral in relation to the preferred paw. Limb preference was demonstrated in rats during performance of a response consisting of withdrawing food from a horizontal tube. Brain tissue dopamine concentrations were estimated by high-performance liquid chromatography with electrochemical detection. The results showed that in "left-handed" rats, the dopamine concentration in the left nucleus accumbens was significantly greater than that in "right-handed" rats. In right-handed rats, the dopamine concentration in the right nucleus accumbens was greater than that in the left. The results obtained here are significantly consistent with data obtained in mice and support the suggestion that the dopamine level in rats is greater in the nucleus accumbens ipsilateral to the preferred limb.

The concentration of dophamine and its derivates is known to correlate with the degree of handedness in manipulative movements in rodents. In this work we studied a possibility to changing handedness in rats by injection of a dopamine agonist into the nucleus accumbens. Retrieving food from a horizontal tube was used to determine the limb preference (10 food retrievals by the preferred limb). Then apomorphine was injected into the n. accumbens ipsilateral to the preferred limb in the course of 7 days. The same volume of buffer solution was injected into the contralateral n. accumbens. Just after the last injection the limb preference was tested. It was shown that the chronic injection of the non-specific agonist of dophamine receptors significantly changed the limb preference.