INTRODUCTION. The prevalence of upper limb dysfunction and cognitive impairments are frequently observed following stroke, but are often considered as distinct entities, and there is little evidence regarding how they are related, as well as rehabilitation methods are aimed at monodomain restoration of any of these impairments. AIM. To analyze the data of recent years on the impact of rehabilitation interventions on cognitive and the upper limb (UL) motor functions in patients with stroke, and to establish how they are related. MATERIAL AND METHODS. The search was carried out in the Medline, Web of Science, PubMed and Scopus sources in accordance with the PRISMA principles and initially revealed 2,841 records. Of these, 35 articles were included in the study with publication 2011–2022. Keywords were used: stroke, movement, motor, upper limb, cognition, cognitive, cognitive-motor, motor-cognitive function. The relationship between cognitive impairments and the degree of restoration of the UL motor function under the influence of various rehabilitation interventions was assessed. RESULTS. Five studies were selected for meta-analysis with the inclusion of 180 stroke patients. It is shown that the improvement of cognitive tests (MoCA) is accompanied by an improvement in UL motor impairments (FMA, Jebsen-Taylor Hand Function Test), while hand dexterity (Box and blocks, NHPT, Minnesota manual dexterity test) remained without statistically significant changes during medical rehabilitation. CONCLUSION. The meta-analysis provides evidence of the relationship and mutual influence of cognitive functions on motor recovery and manual dexterity. However, the small sample size and heterogeneity of available studies are still limiting factors for obtaining unambiguous conclusions.
Cerebral stroke (CS) remains the most important medical and social problem. According to available data, only 25% of stroke survivors return to the premorbid level of daily or work activity, most patients have residual neurological disorders of varying severity. Effective rehabilitation of patients with CS requires not only timely initiation of treatment, but also an individual choice of rehabilitation program. To optimize the rehabilitation strategy in each case, it is necessary to set goals and objectives taking into account the rehabilitation potential (RP) and the prognosis of the patient’s recovery. This paper provides a definition of RP and ways to describe it. The existing neurophysiological methods for assessing the RP of functional recovery after CS, such as electroencephalography, evoked potentials and diagnostic transcranial magnetic stimulation (TMS), are considered. Information about neuroimaging diagnostic methods – computer (CT) and magnetic resonance imaging (MRI) in the context of determining RP is presented. The possibilities of functional and diffusion-t ensor MRI of the brain for assessing RP in various periods of the disease are highlighted in detail. Other possible predictors of the restoration of impaired functions are also considered – the volume and localization of the brain lesion, the patient’s age, cognitive functions and laboratory parameters. Modern complex approaches to the formation of algorithms for the quantitative assessment of RP are described. In particular, the current algorithms for evaluating RP – PREP2 for the upper limb and TWIST for predicting the recovery of walking disorders are described. Currently, there are no generally accepted methods for determining and quantifying RP. The instruments proposed for this purpose are insufficiently sensitive and specific or are not suitable for routine clinical practice.
Аннотация. В данной статье показана эффективность метода количественного сенсорного тестирования в диагностике и лечении хронических болевых синдромов в области лица. Было обследовано 155 пациентов, которые были распределены на группы по установленному диагнозу: группа невралгия тройничного нерва, группа невропатия тройничного нерва, группа миофасциальный болевой синдром лица, на фоне дисфункции височно-нижнечелюстного сустава (МФБСЛ). Так же была проведена ретроспективная оценка 157 историй болезней, в которой пациенты были распределены на такие же группы, но которым не выполнялся метод количественного сенсорного тестирования. Была доказана идентичность двух групп: по возрасту, клинической картине, выраженности болевого синдрома, срокам заболевания, и методам лечения. Для оценки эффективности метода оценивалось количество койко-дней, проведенных пациентом. Полученные данные говорят о снижении койко-дня в группе с использованием метода количественного сенсорного тестирования. Ключевые слова: количественное сенсорное тестирование, КСТ, хронические болевые синдромы, лицевые боли. Annotation. This article shows the effectiveness the method of quantitative sensory testing in the diagnosis and treatment of chronic facial pain syndromes. We examined 155 patients who were divided into groups according to the established diagnosis: trigeminal neuralgia, trigeminal nerve neuropathy, myofascial pain syndrome, with temporomandibular disorder. A retrospective evaluation of 157 case histories was also conducted, in which patients were allocated to the same groups, but they did not perform the quantitative sensory testing method. The identity of the two groups were proved: by age, clinical picture, severity of the pain syndrome, the timing of the disease, and the methods of treatment. To assess the effectiveness of the method, the number of patient days spent in hospital were evaluated. The data obtained indicate a decrease in the days spent in hospital in the group with the quantitative sensory testing.
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