Modern aspects of the pathophysiology of walking disorders and their rehabilitation in post-stroke patients

Khat’kova S.E.; Kostenko E.V.; Akulov M.A.; Diagileva V.P.; Nikolaev E.A.; Orlova A.S.

doi:https://doi.org/10.17116/jnevro201911912243

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Abstract:

The problem of rehabilitation of post-stroke patients with motor deficit remains relevant with growing prevalence of disability and decreasing mortality, despite all measures aimed at stroke prevention and morbidity reduction. One of the most common consequences of stroke is gait impairment as a result of spastic paresis of the lower limb (decreased gait velocity, shortened step, excessive loading of intact limb etc.), which leads to significant maladaptation, increased risk of falls, decrease in quality of life. The article presents a detailed review of motor action in normal and pathologic conditions, analysis of neuronal structures involved into a movement act in healthy individuals and in stroke patients, current aspects of gait pathophysiology, characteristics of post-stroke gait (speed and asymmetry of gain, balance control impairment). A separate paragraph is devoted to gait recovery after stroke with analysis of existing and developing strategies of rehabilitation, aimed at the improvement of vertical posture, balance control and movement, condition, tone and functioning of skeletal muscles. Authors also analyze new research information on the efficacy of botulinum toxin preparations and programs of Guided Self-Rehabilitation Contracts (GSC), present the results of clinical trials demonstrating the efficacy of combination of these two methods.

Keywords:

gait

stroke

hemiparesis

spasticity

botulinum toxin

motor recovery

Authors:

Khat’kova S.E.

Federal state budgetary institution «Medical and Rehabilitation Center», Moscow

Kostenko E.V.

Poliklinika vosstanovitel'nogo lecheniia #7;
Kafedra nevrologii i neĭrokhirurgii Rossiĭskogo gosudarstvennogo meditsinskogo universiteta;
Kafedra nevrologii Moskovskogo gosudarstvennogo mediko-stomatologicheskogo universiteta

Akulov M.A.

FGBNU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Diagileva V.P.

Medical and Rehabilitation Center, Moscow, Russia;
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia

Nikolaev E.A.

Medical and Rehabilitation Center, Moscow, Russia;
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia

Orlova A.S.

I.M. Sechenov First Moscow State Medical University, Moscow

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