Objective: linguistic and cultural adaptation of the original version of Berg Balance Scale (BBS) and assessment its psychometric properties.Patients and methods. The staff of the Validation Center of International Scales and Questionnaires of the Research Center of Neurology received consent from Katherine Berg to validate the BSS in Russia. We carried out the linguocultural ratification during the validation study and prepared a Russian version of the scale. To assess the psychometric properties of the scale (reliability, validity, and sensitivity), we evaluated 55 patients (30 females and 25 males) aged 22–88 years with different neurological disorders (vascular and demyelinating diseases of the central nervous system, peripheral neuropathy, and movement disorders). We analyzed the differences of the total BBS score and the number of patients with high and low risk of falls at the end of rehabilitation compared to baseline to assess the dynamics of changes.Results and discussion. We successfully performed the translation and linguocultural adaptation of the BBS. The scale represents a high level of validity (expert score: 8.6 out of 10 points), reliability (Pearson's correlation coefficient r=0.98, р<0.0001; Cronbach's alpha α=0.94 р<0.001; Cohen's kappa κ=0.71, p<0.0001) and sensitivity (р<0.0001). After a two-week rehabilitation course, the risk of falls significantly decreased (χ2 =4.42; р=0.035); however, the level of independence of movement did not change significantly (F=0.94; р=0.636).Conclusion. The Russian version of the BBS was officially adapted based on the results of the accomplished validation study and is recommended for use both in routine clinical practice and in clinical trials by neurologists and rehabilitologists. The scale is available for downloading by QR code and on the website of Validation Center of International Scales and Questionnaires of the Research Center of Neurology.
Patients with epilepsy may require a neurorehabilitation aid particularly due to developing motor alterations related to stroke, sequelae of traumatic brain injury, multiple sclerosis and other brain damage. Modern neurorehabilitation approaches directly or indirectly affect neuroplastic processes altering cerebral cortex excitability, stimulate the afferentation systems, and result in fatigue and may act as factors provoking seizures or aggravated epilepsy. In addition, developing seizures may temporarily coincide but unrelated to the neurorehabilitation activities: e.g., while omitting antiepileptic drug administration, sleep deprivation or long-term stress occurring to patient etc. Here we present a review on recent studies aimed at investigating epilepsy triggers by aligning them with the factors of interventions used in motor rehabilitation. We also emphasize the safety data for routine use of the main neurorehabilitation methods as well as propose actions to reduce the risk of developing epileptic seizure.
Background. Spasticity is a disabling syndrome frequently observed in progressive multiple sclerosis. One of the promising approaches to the treatment of spasticity is the use of therapeutic intermittent theta‑burst transcranial magnetic stimulation. In the last time new metaplasticity‑based protocols are being developed in order to increase the effectiveness of this technique. These protocols consist of several stimulation sessions in a day with an interval between sessions. However, there is no experience of use of such protocols in spasticity so far.Aim. To assess the safety and tolerability as well as provide first evidence of anti‑spastic effects of an original meta-plasticity‑based intermittent theta‑burst stimulation protocol in patients with progressive multiple sclerosis and spasticity.Materials and methods. In total, 5 patients with progressive multiple sclerosis and spasticity (2 females and 3 males, 28–53 y. o., disease duration – 11–18 years, EDSS – 6.5–8.5 points) were included into the study. 3 sessions of stimulation separated by an interval of 1 hour were applied daily, where a single session consisted of 3 protocols of theta‑burst stimulation with standard duration. Stimulation target was the area of cortical representation of the leg muscles, stimulation was applied consequently to both sides during 5 days (15 sessions in total). Before and after the treatment course anti‑spastic effect (modified Ashworth scale) as well as spasticity‑related pain, fatigue and clinical global impression were assessed.Results. No serious adverse events were observed during the study. Mild adverse events (sleepiness, pain at the stimulation site) developed in some cases, which did not affect patients’ willing to continue participation in the study. After the stimulation course decrease in spasticity in the legs was registered in 4 of 5 patients (to 12–39 % from the basic level). Decrease of fatigue (4 / 5) and pain severity (3 / 5) was also observed.Conclusion. According to the first experience, the proposed original metaplasticity‑based transcranial magnetic stimulation protocol is safe, well‑tolerable and potentially effective in patients with progressive multiple sclerosis. Therefore the further investigation of the protocol in a randomized controlled study seems justified.
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