Medical Medical and social and social significance significance - - PowerPoint PPT Presentation

COMPLEX KINESITHERAPEUTIC APPROACH AFTER SUPRATENTORIAL UNILATERAL STROKE IN THE CHRONIC PERIOD Ass.prof. Danche Vasileva, PhD Full Prof. Daniela Lubenova, PhD



Medical Medical and social and social significance significance

• f str
• f stroke
• ke

Morbidity a Morbidity and nd disa disabili bility ty

Mechanisms for functional recovery

Acute phase Chronic phase

➢ processes take place on: restitution (biological recovery of the brain lesion), adaptive reorganization (engagement of new synapses and neural networks) and / or compensatory strategies (replacement behavior through re-training other than the normal response) ➢ there is a complex bilateral reorganization involving the more intact side (respectively the intact hemisphere).

Effect of kinesitherapy

Acute phase Chronic phase

➢ Stimulates and promotes spontaneous repair of motor disorders. ➢ Stimulates compensatory behavioral strategies related to behavioral reorganization. ➢ It is used to train the non-damaged brain cells in the execution of certain functions.

The aim The aim

The he aim of aim of th the e st stud udy y is is to to e eva valua luate te th the e ef effec ect of t of t the he co comple mplex x kine kinesith sither erape peut utic ic app pproa

• ach

h an and d th the sp e spec eciali ialized ed kine kinesith sither erape peut utic ic met metho hod d (SKTM) (SKTM) in in pa patien tients ts with with su supr prate tent ntor

• rial

ial un unil ilate teral al st strok

• ke

e in in th the e chr hron

• nic

ic pe period riod (SUSC SUSChP hP). ).

Tasks Tasks

1.

• 1. To
• de

develop elop a sp a spec eciali ialized ed me meth thod

• dolo
• logy

y for

• r kin

kines esith ither erapy ba base sed d on

• n th

the e mod moder ern n pr principles inciples of

• f ne

neur uror

• reh

ehabili bilita tation tion an and d ad adapt pted ed for

• r home

home us use e in pa in patien tients ts with with un unila ilate teral al chr hron

• nic

ic st strok

• ke.

e.

Tasks Tasks

2.

• 2. To
• st

stud udy y th the e ea early y (10t (10th h da day) y) an and d la late te (1st (1st mon month th) ) ef effec ect of t of the the app ppli lica cation tion of

• f

sp spec ecializ ialized ed kin kines esith ither erapy y in in pa patie tient nts s with with chr hron

• nic

ic he hemipar mipares esis, is, in in co compa mpariso rison n with with th the e co cont ntrol

• l grou
• up,

, whic hich h is is th the us e usua ual l kin kines esith ither erapy, , on

• n:

(a) (a) motor motor reco ecover ery y fun functionalit ctionalities; ies; (b) (b) equilibrium equilibrium oppor

• pportunit

tunities; ies; (c (c) ) gait gait kine kinetic par tic parame ameter ters; s; d) or d) orthos thosta tatic tic reactiv eactivity ity.

Tasks

3.

• 3. To
• look

look for

• r signifi

significa cant nt co correla elation tions s be betw twee een n so some me pe perma mane nent nt risk risk fac acto tors s (gen (gende der, , age ge) ) an and d st strok

• ke

e cha harac acte terist ristics ics (l (limi imita tation tion, , loca locali liza zation tion an and d se sever erity) ity) on

• n

th the e ef effec ect o t of kin kines esith ither erapy.

Methods Methods of study

• f study

1.

• 1. Sp

Spec ecializ ialized ed kin kines esith ither erap apeu eutic tic met metho hodo dology logy (wi (with th 1 mont 1 month h du dura ration tion); ); 2.

• 2. Usu

Usual al kine kinesith sither erap apeu eutic tic met metho hodo dology logy (wi (with th a 10 a 10 da day y du dura ration tion)

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology

The he pu purpo pose se of

• f SKTM

SKTM Im Impr proving ving the functiona the functional l ca capacity pacity of

• f

pa patients tients with i with isc schemic hemic str strok

• ke

e in in the the chr hronic period

• nic period.

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology Tasks asks

1.

• 1. Impr

Improvem emen ent t of

• f mus

muscle le st stren engt gth, h, sp spas asticity ticity an and d favor

• rable

ble infl influe uenc nce e on

• n

th the e mot motor

• r ca

capa pabili bilities ties of

• f the

the pa patien tient. t. 2.

• 2. Nor

Normaliz malization tion of

• f p

pos

• stu

tural al co cont ntrol

• l in

in sitt sitting ing an and d st stan anding ding.

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology

3.

• 3. Positiv
• sitive

e infl influe uenc nce e on

• n w

walking alking disor disorde ders s an and d fun function ctional al inde indepe pend nden ence ce of

• f th

the pa e patient. tient. 4.

• 4. Impr

Improveme ement nt of

• f o
• rtho

thosta static r tic rea eactivit ctivity y in in pa patients tients wi with th or

• rtho

thosta static into tic intoler leran ance ce. 5.

• 5. Ov

Over erall c all calming alming of

• f the

the bo body dy afte after e r exer ercise cise. . Sp Spee eeding ding up up the r the rec ecover ery pr y proc

• cess

esses es an and d ha having ving a pos a positi itive e ef effec ect on t on the the ner nervou

• us

s syste system. m.

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology

Training aining in in rot

• tating

ting fr from

• m
• c
• ccipita

cipital lay l lay to to side side lying ying po positi sition

• n

Methodological characteristics for practical application of the included movements

Mo Moving ving fr from

• m lying

ying po positi sition

• n

to sea to seat

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology

Mo Moving ving fr from

• m sea

seate ted d to to stan standing ding Mo Moving ving fr from

• m be

bed d to to cha hair ir

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology

Sti Stimula mulating ting a r a rea eact ction of ion of a a su support Mo Moveme ement nts i s in n closed losed kinet kinetic ic cha hain and in and fac acil ilita itating ting

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology

Moveme Movement nts i s in n a semi a semi close closed d kine kinetic tic ch chain ain an and fac d facil ilitating itating Moveme Movement nts i s in n op

• pen

en kine kinetic tic ch chain for ain for up uppe per r li limb mb

Specialized kinesitherapeutic methodology

Seat wi Seat with th an and d wi with thou

• ut

t th the sup e suppo port rt of

• f

th the lower e lower li limbs mbs Moving Moving from from sea seate ted d to to sta stand nding ing Training aining in in inde indepe pend nden ent t sta stanc nce

Specialized kinesitherapeutic methodology

Training Training in in sta stand nding ing po positi sition

• n wi

with th weight weight tra transfe nsfer Walking Walking tra training ining

Comparative characteristics between SCTM and control methodology

The applied two kinesitherapy techniques are different in their duration of treatment, structure and included kinesitherapeutic agents (postural movements, walking, active upper limb movements and transfers). SCTM adheres to the principles of modern neurorehabilitation and motor training, as

• pposed to conventional kinesitherapy.

Methods Methods for evaluating the for evaluating the tr treatment performed eatment performed

➢ Che Chedo doke-McMast McMaster er te test st to to as asse sess ss th the e se sever erity ity of

• f mo

moveme ement nt res estr triction ictions s in in (po (point ints) s) ➢ Ash Ashwor

• rth

th Sca Scale le for

• r Musc

Muscle le Ton

• ne

e Ass Asses essme sment nt (point (points) s) ➢ Fu Func nctio tiona nal l ind indep epen ende denc nce e me meas asur ure e (point (points) s) ➢ Ber Berg g ba balanc lance e sc scale ale (point (points) s) ➢ Ga Gait it St Stud udy y - Ca Cada danc nce (nu (numb mber er of

• f ste

steps ps) ) an and d sp spee eed d (m (m / min) / min) ➢ Act Activ ive e or

• rth

thos

• sta

tatic tic te test st

Methods Methods

Sta Statist tistical ical meth method

• ds

1.

• 1. Vari

Variation ation (S (Stud tuden ent-Fish Fisher t er t-test), test), 2.

• 2. Al

Alterna ternative tive 3.

• 3. Correla

Correlation tion an analys alysis is 4.

• 4. Wil

Wilco coxo xon n test test 5.

• 5. Th

The e Man Mann-Whit Whitney U ney U-test test 6.

• 6. Pa

Paired ired Sa Samples mples Te Test st 7.

• 7. Sp

Spea earman rman co correlati rrelation

• n a

ana nalysis lysis

Study contingent Study contingent

Con Continge tingent nt

Includ Including ing cr criter iteria: ia:

➢ Su

Supra praten tentorial un torial unil ilate ateral strok ral stroke

➢ Have

Have m mil ild d or mode

• r moderate residu

rate residual, al, ch chron ronic ic he hemi mipa paresis resis

➢ Medica

Medication thera tion therapy sh py shou

• uld

ld no not b t be e altered altered during during motor motor the therap rapy

Continge Contingent nt

Includ Including ing cr criter iteria: ia:

➢ Do n

Do not ha

• t have

ve sev severe ere somatic somatic dise disease ases s - ac acute ute isch ischemic he emic heart diseas art disease, r e, resp espiratory iratory fail failure ure, , ca cardio rdiova vasc scula ular r failure failure, u , unc ncon

• ntrolled

trolled dia diabe betes tes mell mellitus, itus, ac acute ute thromb thrombop

• phleb

hlebiti itis

➢ Have

Have no co no cogn gniti itive a ve and nd memory impairment memory impairment

➢ No seve

No severe prog re progress ressive ive ne neuro urologica logical l dise disease ases

➢ Have

Have given given i info nformed co rmed conse nsent nt to pa to parti rticipa cipate te in in the the stud study

Continge Contingent nt

Exclusion Exclusion criter criteria ia: :

➢ pa

patients w tients with ith ac acute ute strok stroke

➢ bra

brain hemo in hemorrhag rrhages es pe performed rformed

➢ pre

presen sence ce of bil

• f bilate

ateral o ral or seve r severe pa re pause uses

➢ pa

patients w tients who ho refuse refused to pa d to parti rticipa cipate te in t in the he study study for various for various rea reason sons

Continge Contingent nt

Inc Includ luded ed in th in the e st stud udy 67 67 pa patien tients ts with with ISChP ISChP

Ex Expe perimen rimental tal grou

• up

56 56 pa patients tients Sp Spec eciali ialized ed kin kines esithe itherape peutic utic meth method

• dolog
• logy

y Contr Control g

• l grou
• up

11 11 pa patients tients Usu Usual al kin kines esithe itherape peutic utic meth method

• dolog
• logy

y

Contingent c Contingent char haracterist acteristics ics

In Indica dicator tors Patients tients Moderate te degree Easy Easy de degree ee Exp Experimen erimental tal grou

• up

n=56 n=56 n= n=33 33 n= n=23 23 Age ge 63 63.2±8.8 8.8 63 63.9 .9±7.1 62 62.3±10 10.9 Se Sex (m m / / f) 32 32/24 24 22 22/11 /11 10/1 /13 Dur uration tion (m) m) 7.8 7.8±2.01 2.01 8.3 8.3±2.2 2.2 7.2 7.2±1.5 1.5 Lo Loca cali liza zation tion (L / L / R) 26 26/30 30 16 16/17 /17 10/1 /13 Con

• ntr

trol

• l grou
• up

n=1 =11 n=5 n=6 Age ge 63 63.3 .3±6.0 6.0 63 63.6 .6±5.3 5.3 63 63.1 .1±7.1 7.1 Se Sex x (m (m / / f) f) 9/2 9/2 5/0 /0 4/2 4/2 Dur uration tion (m) m) 7.3 7.3±1.5 1.5 7.6 7.6±1.8 1.8 7.0 7.0±1.2 1.2 Lo Loca cali liza zation tion (L / L / R) 5/6 5/6 2/3 2/3 3/3 3/3

Clinical Clinical character characteristics istics of the

• f the

contingent contingent

Risk Risk fac actor tors

0,0 30,0 60,0 90,0 120,0

CVD ChPD Diabetes II type Smokers Non smokers CVD ChPD Diabetes II type Smokers Non smokers Experimental group Control group

%

Own results Own results

Effect Effect on

• n the

the func function tionality ality of moto

• f motor

r re reco cove very ry

Ched Chedok

• ke-McMas

McMaster ter

Beginning - 10th day Beginning - 1st month Beginning - 10th day Beginning - 1st month Upper limb Lower limb Experimental 0,98 1,63 0,89 1,2 Control 0,82 0,27 0,91 0,45 0,5 1 1,5 2 2,5

Difference

Ashw Ashwor

• rth

th

Effect Effect on

• n the

the func function tionality ality of moto

• f motor

r re reco cove very ry

Beginning - 10th day Beginning - 1st month Beginning - 10th day Beginning - 1st month Upper limb Lower limb Experimental

• 0,77
• 1,12
• 0,55
• 0,95

Control

• 0,55
• 0,23
• 0,59
• 0,23
• 1,2
• 1
• 0,8
• 0,6
• 0,4
• 0,2

Difference

Effect Effect on

• n f

fun unct ctiona ional l inde indepe pend nden ence ce

5 10 15 20 25 30 35 40 Beginning - 10th day Beginning - 1st month Experimental 18,92 23,19 Control 10,9 5,45

Differences

Tota

• tal

l nu numbe mber r of

• f po

points ints of

• f F

FIM IM

Effect Effect on

• n balan

balance ce ca capa pabili bilities ties

Beginning - 10th day Beginning - 1st month Experimental 22,86 27,36 Control 14,36 7,64 5 10 15 20 25 30 35 40 Differences

Tota

• tal

l nu numbe mber r of

• f p

points

• ints - Ber

Berg

Effect Effect on

• n balan

balance ce ca capa pabili bilities ties

Correlation Correlation de depe pend nden encies cies

20 30 40 50 60 90 100 110 120 130

BER ERG FIM FIM

10 10th th day day

КГ ЕГ

20 30 40 50 60 90 100 110 120 130

BER ERG FIM FIM

1st st mon month th

ЕГ КГ

Effect Effect on

• n the

the kine kinemat matic ic pa para ramet meter ers s of gait

• f gait

Beginning - 10th day Beginning - 1st month Beginning - 10th day Beginning - 1st month 6 m 10 m Experimental group

• 1,5
• 2,34
• 2,32
• 4,13

Control group

• 0,73
• 0,41
• 1,45
• 0,64
• 7
• 6
• 5
• 4
• 3
• 2
• 1

Differences in the number of steps

• n 6 m and 10 m

Cada Cadanc nce of

• f g

gait ait

Effect on the kinematic parameters of gait

Beginning - 10th day Beginning - 1st month Experimental group 8,11 14,77 Control group 6 5,36 5 10 15 20 25

Differences in m / min

Spe Speed ed of

• f g

gait ait m m/mi /min

Cha Chang nges es in in th the pe e perc rcen enta tage ge dist distribu ribution tion of

• f

pa patien tients ts ac acco cord rding ing to to ort

• rtho

host stat atic ic re reac activity tivity

***

10 20 30 40 50 60 70 80

at the beginning 10 day 1 month at the beginning 10 day 1 month Experimental group Control group

%

NOR SOR HOR

*** ** **

Conclude Conclude

1. 1.

The spe The specializ cialized ed kine kinesithe sithera rapy py metho methodology dology develope developed d and and ap appr prove

• ved

d by us, by us, co cont ntinue inued d late later as r as a 1 a 1-mon month th home home ex exer ercise cise pr prog

• gra

ram, m, ha has a s a po positi sitive ea ve early a rly and nd late late th ther erap apeu eutic tic effe ffect on t on the the:

➢

fun funct ctiona ional l po possibil ssibiliti ities es for mot for motor

• r re

reco cover very, y,

➢

eq equili uilibr brium, ium,

➢

ga gait a it and nd

➢

• rth

rthosta static tic re reactivity tivity in in pa patien tients w ts with ith IS in IS in th the ch e chro ronic nic pe period riod. . In In co cont ntra rast, st, th the e 10 10-day routine day routine kine kinesithe sithera rapy py ha had d a a sho short rt-te term rm (up (up to to 10 10-da day) positive y) positive effe effect ct, a , and nd a 1 a 1-mon month th follow follow-up up sho showed wed a re a retu turn rn to ba to baseline. seline.

Conclude Conclude

2. 2.

Th The e differen difference ces s be between tween the the e effects ffects of the

• f the

two two co compa mpared red kine kinesithera sitherapy py tec techn hnique iques s see seen n at 1 month at 1 month after a after app ppli lica cation tion are are rel relate ated d to to differen difference ces s in t in the he dura duration of app tion of appli lica cation, tion, the the struc structure ture of ap

• f application, and

plication, and the the ap appro propria priaten tenes ess s of the

• f the kine

kinesitherapy sitherapy ag agen ents ts invo involved lved.

Conclude Conclude

3. 3.

Th The e po positi sitive ve ea early rly an and d late late kine kinesithera sitherapy py effec effect t de depe pend nds s on

• n the sev

the severity erity of

• f the

the d disea isease se an and d is is inde indepe pend nden ent t of the ge

• f the gend

nder, er, ag age, e, loca location an tion and d li limit mitation ation of

• f strok

stroke. e.

Conclude Conclude

4. 4.

Th The e implemen implemented ted spe specialized cialized kine kinesithera sitherapy py improve improves the ba s the balanc lance e ca capa pabili bilities of t ties of the he pa patients foll tients followe

• wed, wh

d, which is a ich is asso ssociate ciated d wi with th improve improved fun d function ctional al inde indepe pend nden ence ce an and ga d gait it du during treatmen ring treatment. t..

Conclude Conclude

5. 5.

Appro Approba bation tion kine kinesithera sitherape peutic utic meth method

• dolog
• logy,

y, the the nee need d for daily a for daily ada dapte pted d for home for home, , pu purpo rposefu seful l ph physica ysical l ac activi tivity ty to to ac achiev hieve e lasting lasting resu results a lts and nd incre increase ase f fun unction ctionalit ality i y in pa n patients tients wi with th IS IS in in ch chron ronic ic pe period riod.

Thank hank you

• u for y
• r your
• ur atte

ttention ntion