Krasnikova V V, Bagramyan S A, Demchenko E A
Almazov National Medical Research Center, St. Petersburg, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2022;99(2):23-31. doi: 10.17116/kurort20229902123.
Dyscirculatory encephalopathy is a complex of functional and structural changes in the brain that occur against the background of chronic insufficiency of cerebral blood flow. The high prevalence of this pathology, as well as a pronounced impact on the quality of life and working capacity of patients, determines the importance of optimizing rehabilitation measures and developing the most promising strategies for physical rehabilitation.
To compare the effectiveness of a special complex of therapeutic (vestibular) gymnastics and training with biofeedback (BFB) on a stabiloplatform in the rehabilitation of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome.
A cohort prospective single-center randomized comparative study of the clinical effectiveness of the author's complex of therapeutic exercises and stabilometric training with BFB in the complex treatment of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome was carried out. The study involved 40 patients aged 65-89 years who were randomized into 2 equal groups. Patients of the 1st group, against the background of drug therapy and physiotherapy, were trained on a stabiloplatform with BFB (a training game according to the manufacturer's instructions). Patients of the 2nd group performed a complex of therapeutic (vestibular) gymnastics specially designed for this study. The effectiveness of physical rehabilitation was assessed by the dynamics of (1) subjective symptoms (complaints of patients), (2) indicators of stabilometry (symmetry index, the sum of the coordination indices for the right and left legs, fluctuation) and (3) the results of functional testing using the Get up and go test, the Berg balance scale and the Tinetti mobility scale.
In the group of patients who performed vestibular gymnastics, in contrast to patients who participated in training using a multifunctional stabiloplatform with BFB, a statistically significant improvement was revealed when assessed by the Get up and go test and the Berg balance scale. In none of the groups, a distinct dynamics of stabilometry indicators was registered. No correlation was found between the main indicators of stabilometry and the data of functional tests.
Thus, vestibular gymnastics has demonstrated greater effectiveness in the rehabilitation of patients with dyscirculatory encephalopathy and vestibulo-atactic syndrome in comparison with stabilometric training with biofeedback. The discrepancy between stabilometry indicators and the results of functional testing in patients requires a targeted study.
循环障碍性脑病是在脑血流长期不足的背景下发生的脑功能和结构改变的综合体。这种病理状况的高患病率，以及对患者生活质量和工作能力的显著影响，决定了优化康复措施和制定最有前景的身体康复策略的重要性。
比较特殊的治疗性（前庭）体操和在稳定平台上进行生物反馈（BFB）训练对患有前庭共济失调综合征的循环障碍性脑病患者康复的效果。
对作者的治疗性运动综合体和使用BFB的稳定测量训练在患有前庭共济失调综合征的循环障碍性脑病患者综合治疗中的临床效果进行了一项队列前瞻性单中心随机对照研究。该研究纳入了40名年龄在65 - 89岁之间的患者，他们被随机分为两组。第一组患者在药物治疗和物理治疗的基础上，在带有BFB的稳定平台上进行训练（按照制造商的说明进行训练游戏）。第二组患者进行专门为本研究设计的治疗性（前庭）体操。通过以下方面的动态变化评估身体康复效果：（1）主观症状（患者的主诉），（2）稳定测量指标（对称指数、左右腿协调指数之和、波动），以及（3）使用起立行走测试、伯格平衡量表和蒂内蒂运动量表进行功能测试的结果。
与参与使用带有BFB的多功能稳定平台训练的患者相比，进行前庭体操的患者组在起立行走测试和伯格平衡量表评估时显示出统计学上的显著改善。在任何一组中，均未记录到稳定测量指标的明显动态变化。稳定测量的主要指标与功能测试数据之间未发现相关性。
因此，与生物反馈稳定测量训练相比，前庭体操在患有循环障碍性脑病和前庭共济失调综合征患者的康复中显示出更大的效果。患者稳定测量指标与功能测试结果之间的差异需要进行针对性研究。
