Kaurkin S N, Skvortsov D V, Ivanova G E, Lobov A N, Zhuravleva A I
Federal research and clinical centre for specialized types of medical assistance and medical technologies of the Federal medical-biological Agency of Russia, Moscow, Russia; N.I. Pirogov Russian National Research Medical University, Moscow, Russia.
N.I. Pirogov Russian National Research Medical University, Moscow, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2018;95(3):26-34. doi: 10.17116/kurort201895326.
The impaired function of the shoulder joint resulting from cerebral stroke is a common disorder involving permanent total disability as well as impaired capability of self-care. The functional pathological changes in the shoulder joint and the dynamics of the patients' health status during the acute period of cerebral stroke remain virtually unexplored.
The objective of the present study was to obtain a deeper insight into the process of recovery of the movements in the shoulder joint of the patients presenting with hemiparesis during the acute period of hemispheric stroke based on the results of the analysis of the biomechanical data and the targeted training with biofeedback (BFB).
The study included three groups comprised of 25 subjects each. One (control) group included the subjects having neither neurological nor orthopedic pathology. The second group consisted of the patients receiving the conventional treatment in the combination with therapeutic physical exercises (TPE). Group 3 was composed of the patients given the standard course of conventional and physical (TPE) therapy complemented by biofeedback training (the TPE/BFB group). The study included clinical investigations and biomechanical registration of the movements of the shoulder joints and trunk.
The results of the study gave evidence that the patients presenting with hemiparesis during the acute period of hemispheric ischemic stroke including those treated with the application of the active means and methods of rehabilitation, such as BFB training, showed no appreciable dynamics of the parameters being evaluated with the use of the relevant clinical scales. The biomechanical study has demonstrated that the movements in the shoulder joints (in a single plain) of the patients comprising the control group are characterized by the presence of the main component with a maximum amplitude in the plane of this movement and additional components (in other planes with a significantly lower amplitude); they are accompanied by the ancillary movements of the trunk. Functionally, the condition of paresis at the level of the shoulder joint is characterized by a decrease in the amplitude of the primary movement and the increase of one of the additional amplitudes, with the growing amplitude of the auxiliary movements of the trunk. The biomechanical methods for the objective assessment have revealed the following functional changes in the shoulder joints: the 6% improvement of flexion in the group of the patients treated with the use of therapeutic physical exercises and the 10% improvement in those treated with the combination of TPE and BFB. Moreover, abduction in the patients of these two groups improved by 4% and 9% respectively.
The method for the study of kinematics of the movements in the shoulder joints appears to be most sensitive and informative for the purpose of diagnostics of disorders of the motor function and assessment of the process of its restoration in the patients presenting with hemiparesis during the acute period of hemispheric stroke.
脑卒中导致的肩关节功能障碍是一种常见疾病，会导致永久性完全残疾以及自理能力受损。脑卒中急性期肩关节的功能病理变化以及患者健康状况的动态变化实际上仍未得到探索。
本研究的目的是基于生物力学数据分析结果和生物反馈（BFB）靶向训练，更深入地了解半球性脑卒中急性期偏瘫患者肩关节运动的恢复过程。
该研究包括三组，每组25名受试者。一组（对照组）包括既无神经病理学也无骨科病理学的受试者。第二组由接受常规治疗并结合治疗性体育锻炼（TPE）的患者组成。第三组由接受常规和物理（TPE）治疗标准疗程并辅以生物反馈训练的患者组成（TPE/BFB组）。该研究包括临床调查以及肩关节和躯干运动的生物力学记录。
研究结果表明，半球性缺血性脑卒中急性期出现偏瘫的患者，包括那些接受积极康复手段和方法（如BFB训练）治疗的患者，使用相关临床量表评估的参数没有明显变化。生物力学研究表明，对照组患者肩关节（在单个平面内）的运动特征是在该运动平面内存在最大振幅的主要成分以及其他成分（在其他平面内，振幅明显较低）；它们伴随着躯干的辅助运动。在功能上，肩关节水平的轻瘫状况表现为主要运动振幅降低，一个其他振幅增加，同时躯干辅助运动的振幅增加。客观评估的生物力学方法揭示了肩关节的以下功能变化：接受治疗性体育锻炼的患者组中屈曲改善了6%，接受TPE和BFB联合治疗的患者组中屈曲改善了10%。此外，这两组患者的外展分别改善了4%和9%。
肩关节运动的运动学研究方法似乎对诊断运动功能障碍以及评估半球性脑卒中急性期偏瘫患者运动功能恢复过程最为敏感且信息丰富。
