r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2024-29-6-44-50r-n-j-637Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSРезультативность тренинга ходьбы у пациентов с центральным гемипарезомEffectiveness of walking training in patients with central hemiparesishttps://orcid.org/0000-0002-3429-9640ЯстребцеваИ. П.YastrebtsevaI. P.

Иваново

Москва

Ivanovo

Moscow

ip.2007@mail.ruhttps://orcid.org/0009-0004-5163-3585МанукянК. А.ManukyanK. A.

Иваново

Ivanovo

m.karine30@mail.ruhttps://orcid.org/0009-0009-9760-8007ШумаринаЕ. Л.ShumarinaE. L.

Иваново

Ivanovo

katia11062001@mail.ruhttps://orcid.org/0000-0003-4387-9433БеловаВ. В.BelovaV. V.

Иваново

Ivanovo

ivoreab37@mail.ruИвановский государственный медицинский университет; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияIvanovo State Medical University; N.I. Pirogov Russian National Research Medical UniversityRussian FederationИвановский государственный медицинский университетРоссияIvanovo State Medical UniversityRussian Federation2024310120252964450Copyright © Ястребцева И.П., Манукян К.А., Шумарина Е.Л., Белова В.В., 20252025Ястребцева И.П., Манукян К.А., Шумарина Е.Л., Белова В.В.Yastrebtseva I.P., Manukyan K.A., Shumarina E.L., Belova V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/637

Улучшение ходьбы остается важнейшей задачей реабилитации, а эффективность ранее предложенных методов отработки двигательного навыка требует дальнейшего улучшения.Цель работы — оценить результаты тренинга ходьбы по показателю «период опоры» в комплексной реабилитации пациентов с центральным гемипарезом в раннем восстановительном периоде ишемического инсульта (ИИ), а также выявить факторы, сопутствующие улучшению походки.Материал и методы. Обследовано 49 пациентов с центральным гемипарезом (легким и умеренным в стопе) в раннем восстановительном периоде ИИ. Больные были рандомизированы в основную группу из 28 человек и группу сравнения — 21 пациент. Больным основной группы дополнительно к стандартам оказания помощи применялся тренинг с визуальной биологической обратной связью (БОС) по «периоду опоры». Дважды проводилось функциональное тестирование, оценка биомеханических показателей ходьбы и регистрация поверхностной электромиограммы (ЭМГ) с мышц бедра и голени. Курс тренировок состоял из 10 занятий по 15 [10;20] минут.Результаты. Тренировки с использованием БОС у пациентов в раннем восстановительном периоде ИИ сопровождались улучшением ходьбы и оптимизацией биомеханических показателей (периода опоры, длины цикла шага, двойной опоры, бокового отклонения стопы), а также нейрофизиологических — амплитуды ЭМГ с четырехглавой мышцы бедра.Заключение. У пациентов с центральным гемипарезом в раннем восстановительном периоде ИИ тренинг ходьбы сопровождался ее улучшением одновременно с повышением динамической составляющей равновесия.

Improving walking remains the most important goal of rehabilitation, and the effectiveness of previously proposed methods of practicing the motor skill requires further improvement.The aim of the work is to evaluate the results of walking training according to «the period of support» in the comprehensive rehabilitation of patients with central hemiparesis in the early recovery period of ischemic stroke, as well as to identify factors concomitant with gait improvement.Material and methods. 49 patients with central hemiparesis (mild and moderate in the foot) in the early recovery period of ischemic stroke were examined. The patients were randomized into the main group of 28 patients and the comparison group of 21 patients. The patients of the main group in addition to the standards of care were trained with visual biofeedback on the period of support. Functional testing, assessment of biomechanical indicators of walking and taking surface electromyograms from the thigh and lower leg muscles were performed twice. The training course consisted of 10 sessions of 15 [10;20] minutes each.Results. Training with the use of biofeedback in patients in the early recovery period of stroke was accompanied by improvement of walking as a daily activity and optimization of biomechanical indices of support period, step cycle length, double support, lateral deviation of the foot, as well as neurophysiological — EMG amplitude of EMG m.Quadriceps femoris.Conclusion. In patients with central hemiparesis in the early recovery period of ischemic stroke, walking training was accompanied by its improvement simultaneously with an increase in the dynamic component of balance.

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The authors declare that there are no conflicts of interest present.