Modern aspects of organization of rehabilitation in stroke patients
https://doi.org/10.18705/1607-419X-2015-21-2-206-217
Abstract
Stroke is the most widely spread reason of disability. In Russian Federation the number of disabled people is higher than in Europe, that is partly due to the underdeveloped rehabilitation system. The present article discusses the medical, physical, psychological, social, professional and pedagogical issues of rehabilitation in stroke patients. The main causes of stroke in young subjects are reviewed, and the main aspects of rehabilitation in patients with movement, speech and cognitive post-stroke dysfunction are presented. The early rehabilitation is of great importance for the recovery, and should be aimed at the prevention of post-stroke complications (pneumonia, venous thrombosis etc.). It is worth noting that post-stroke cognitive impairment is associated with worse outcome and higher death rate, that is extremely important as dementia rate in patients after stroke can reach 26 %. The role of medical supply and, in particular, nicergoline (a drug with both vasoactive and neurometabolic properties) effects are discussed. Complex rehabilitation procedures lead to the cognitive improvement (proved by neuropsychological exams) and to the decrease in post-stroke movement disorder.
About the Authors
E. R. Barantsevich
Federal North-West Medical Research Centre, St Petersburg, Russia
Russian Federation
Russian Federation
MD, PhD, MDSc, Professor, Head, Department of Neurology, Almazov Federal North-West Medical Research Centre;
V. V. Kovalchuk
St Petersburg Municipal Hospital No 38 named after N. A. Semashko, St Petersburg, Russia
Russian Federation
Russian Federation
MD, PhD, MDSc, Professor, Head, Department of Rehabilitation of Patients with Neurological Diseases, St Petersburg Municipal Hospital No 38 n.a.N.A. Semashko;
D. A. Ovchinnikov
Federal North-West Medical Research Centre, St Petersburg, Russia
Russian Federation
MD, Junior Researcher, Research Laboratory of Myocardium Metabolism, Federal North-West Medical Research Centre;
Russian Federation
MD, Junior Researcher, Research Laboratory of Myocardium Metabolism, Federal North-West Medical Research Centre;
Yu. V. Sturova
Krasnodar Regional Hospital, Krasnodar, Russia
First Pavlov State Medical University of St. Petersburg, St Petersburg, Russia
Russian Federation
Russian Federation
MD, Neurologist, Krasnodar Regional Hospital, PhD student, Department of Neurology and Manual Therapy, First Pavlov State Medical University of St. Petersburg.
References
1. Гехт А. Б. Ишемический инсульт: вторичная профилактика и основные направления фармакотерапии в восстановительном периоде. Consilium medicum. 2001;5:227–232. [Geht AB. Ischemic stroke: Secondary prophylactic therapy and farmacotherapy at recovery period in patients with ischemic stroke. Consilium medicum. 2001;5:227–232. In Russian].
2. Гусев Е. И., Скворцова В. И. Ишемия головного мозга. М.: Медицина; 2001. 328 c. [Gusev EI, Skvortsova VI. Ischaemia of the brain. Мoscow: Meditsina = Medicine; 2001. 328 p. In Russian].
3. Скворцова В. И. Ишемический инсульт: патогенез ишемии и терапевтические подходы. Неврологический журнал. 2001;3:4–9. [Skvortsova VI. The Ischaemic stroke, Ischemia pathogenesis and therapeutic approaches in ischemic stroke. Nevrologicheskij zhurnal = Neurological journal. 2001;3:4–9. In Russian].
4. Скворцова В.И, Иванова Г. Е., Гудкова В. В. и др. Принципы ранней реабилитации больных с инсультом. Журнал неврологии и психиатрии им. С. С. Корсакова. Инсульт (приложение к журналу). 2002:7:28–33. [Skvortsova VI, Ivanova GE, Gudkova VV et al. Early rehabilitation approach in patients with stroke. Zhurnal nevrologii i psikhiatrii imeni S. S. Korsakova = Journal of Neurology and Psychiatry named after Korsakov. Stroke (Appendix). 2002;7:28–33. In Russian].
5. Сорокоумов В. А. Методические рекомендации по организации неврологической помощи больным с инсультами в Санкт-Петербурге. СПб.: Человек; 2002. 48 c. [Sorokoumov VA. Recommendations of neurological care organization for stroke patients. St Petersburg: Chelovek = The Man; 2002. 48 p. In Russian].
6. Суслина 3.А., Варакин Ю. Я. Эпидемиологические аспекты изучения инсульта. Время подводить итоги. Анналы клинической и экспериментальной неврологии. 2007:2;22–28. [Suslina ZA, Varakin UYa. Epidemiological aspects of stroke’s study. The time of conclusion. Annaly klinicheskoj i ehksperimental’noj nevrologii = Annals of Clinical and Experimental Neurology. 2007;2:22–28. In Russian].
7. Bonita R, Stewart A, Beaglehole R. International trends in stroke mortality: 1970–1985. Stroke 1990;21(7):989–992.
8. McGovern PG, Shahar E, Sprafka JM, Pankow JS. Stroke rates during the 1980s: The Minnesota Stroke Survey. Stroke. 1997;28:275–279.
9. Верещагин Н. В. Гетерогенность инсульта: взгляд с позиций клинициста. Журнал неврологии и психиатрии им. С. С. Корсакова. Инсульт (приложение к журналу). 2003:9;8–9. [Heterogenity of stroke: physician’s opinion. Zhurnal nevrologii i psikhiatrii imeni S. S. Korsakova = Journal of neurology and psychiatry named after S. S. Korsakov. Stroke (Appendix). 2003;9:8–9. In Russian].
10. Трошин В. Д., Густов А. В., Трошин О. В. Острые нарушения мозгового кровообращения: Руководство (2-е издание, переработанное и дополненное). Нижний Новгород: НГМА; 2000. 440 c. [Troschin VD, Gustov AC, Troschin OV. Stroke. Guideline. N. Novgorod: NGMA; 2000. 440 p. In Russian].
11. Adams HPJr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41.
12. Machoney F, Barthel D. Functional evalution: the Barthel Index. Md State Med J. 1965;14:61–65.
13. Wade DT. Measurement in neurological rehabilitation. New York: Oxford University Press; 1992. p. 308.
14. Bernhardt J, Dewey H, Thrift A, Collier J, Donnan G. A Very Early Rehabilitation Trial for Stroke (AVERT): phase II safety and feasibility. Stroke. 2008;39:390–396.
15. Белова Н. А. Нейрореабилитация: руководство для врачей. М.: Антидор; 2000. 568 c. [Belova NA. Neurorehabilitation: the guideline for physicians. Moscow: Antidor; 2000. 568 p. In Russian].
16. Brott T, Adams HP, Olinger CP. Measurements of acute cerebral infarction: A clinical examination scale. Stroke. 189:20;864–870.
17. Демиденко Т. Д., Ермакова Н. Г. Основы реабилитации неврологических больных. СПб.: Фолиант; 2004. 300 c. [Demidenko TD, Ermakova NG. Essential principles of neurological patients’ rehabilitation. St Petersburg: Foliant = Folio; 2004. 300 p. In Russian].
18. Кадыков А. С. Реабилитация после инсульта. М.: Миклош; 2003. 176 c. [Kadikov AS. The rehabilitation after stroke. Moscow: Miklosh. 2003. 176 p. In Russian].
19. Warlow CP, Dennis MS, van Gijn J, Sandercock PAG, Bamford JM, Wardlaw JM. Stroke. A practical guide to management. London: Blackwell Science. 1997. 664 p.
20. Камаева О. В., Монро П., Буракова З. Ф., Зычкова О. Б., Иванова А. А., Сорокоумов В.А и др. Мультидисциплинарный подход в ведении и ранней реабилитации неврологических больных: Методическое пособие. Часть 5. Physical therapy. Под ред. А. А. Скоромца. СПб.; 2003. 42 с. [Kamaeva OV, Monro P, Burakova ZF, Zychkova OB, Ivanova AA, Sorokoumov VA et al. (The Editor Skoromets AA.) The multidisciplinary approach in the treatment and early rehabilitation of neurological patients. Methodical manual. Part 5. 2003. 42 p. In Russian].
21. Дамулин И. В. Спастичность после инсульта. Русский медицинский журнал. 2005:7;3–7. [Damulin IV. The spasticity after stroke. Russkiy medicinskiy zhurnal = Russian medical journal. 2005;7:3–7. In Russian].
22. O’Brien CF, Seeberger LC, Smith DB. Spasticity after stroke. Epidemiology and optimal treatment. Drugs Aging. 1996;9 (5):332–340.
23. Stamenova P, Koytchev R, Kuhn K et al. A randomized, double blind, placebo-controlled study of the efficacy and safety of tolperisone in spasticity following cerebral stroke. Eur J Neurol. 2005;12(6)453–461.
24. Галкин А. С., Баранцевич Е. Р., Гусев А. О., Миннуллин Т. И., Ковальчук В. В., Самус Н. Л. и др. Возможности повышения эффективности реабилитации пациентов после инсульта с синдромом игнорирования. Журнал неврологии и психиатрии им. С. С. Корсакова. 2014:10;30–34. [Galkin AS, Barantsevich ER, Gusev AO, Minnullin TI, Kovalchuk VV, Samus NL et al. Possibilities to increase the patients with neglect rehabilitation efficiency after stroke. Zhurnal nevrologii i psikhiatrii imeni S. S. Korsakova = Journal of neurology and psychiatry named after S. S. Korsakov. 2014;10:30–34. In Russian].
25. Дамулин И. В. Постинсультная деменция. Некоторые диагностические и терапевтические аспекты. Психиатрия и психофармакотерапия. 2005;1:28–32. [Damulin IV. Poststroke dementia. Diagnostic and therapeutic points. Psihiatriya i psihofarmakoterapiya = Psychiatry and psychofarmacotherapy. 2005:1:28–32. In Russian].
26. Яхно Н. Н., Захаров В. В., Локшина А. Б, Коберская Н. Н., Мхитарян Э. А. Деменции. Руководство для врачей (2-е издание). М.: МЕДпресс-информ; 2010. 272 c. [Yahno NN, Zakharov VV, Lokshina AB, Koberskaya NN, Mkhitaryan EA. Dementia. The guideline for physicians. Moscow: Medpress-inform; 2010. 272 p. In Russian].
27. Roman GC. Facts, myths, and controversies in vascular dementia. J Neurol Sci. 2004;226(1–2):49–52.
28. Руденко Г. М., Музыченко А. П. Результаты клинического изучения препарата Сермион (анализ данных Фармакологического Комитета). М., 1987. 31 c. [Rudenko GM, Muzichenko AP. Results of clinical research of Sermion. (the analysis of Farmakological committee information). Moscow; 1987. 32 p. In Russian].
29. Виндиш М. Лекарства, усиливающие когнитивные функции (ноотропы). М.: ЭБЕВЕ; 2001. 23 c. [Vindish M. Improving cognitive function drugs. Moscow: Ebewe; 2001. 23 p. In Russian].
30. Crook TH. Nicergoline: Parallel evolution of clinical trial methodology and drug development in dementia. Dement Geriatr Cogn Disord. 1997;8 (1):22–26.
31. Fioravanti M, Flicker L. Nicergoline for dementia and other age associated forma of cognitive impairment. The Cochrane Library. 2007;1:1–22.
32. Winblad B, Carfagna N, Bonura L. Nicergoline in dementia. A review of its pharmacological properties and therapeutic potential. CNS Drugs. 2000;14:267–287.
33. Winblad B, Fioravanti M, Dolezal T, Logina I, Milanov IG, Popescu DC после, в конце оставить et al. Therapeutic use of nicergoline. Clin Drug Invest. 2008;28:533–552.
34. Шток В. Н. Клиническая фармакология вазоактивных средств и фармакотерапия цереброваскулярных расстройств. М.: МИА; 2009. 583 c. [Schtok VN. Clinical pharmacology of vasoactive drugs and pharmacotherapy of cerebrovascular disorders. Moscow: MIA; 2009. 583 p. In Russian].
35. Winblad B, Carfagna N, Bonura L et al. Nicergoline in dementia. A review of its pharmacological properties and therapeutic potential. CNS Drugs. 2000;14:267–287.
36. Adams HPJr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41.
37. Adams HPJr. Investigation of the patient with ischaemic stroke. Cerebrovasc Dis. 1991;1(1):54–60.
Review
For citations:
Barantsevich E.R., Kovalchuk V.V., Ovchinnikov D.A., Sturova Yu.V. Modern aspects of organization of rehabilitation in stroke patients. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2015;21(2):206-217. (In Russ.) https://doi.org/10.18705/1607-419X-2015-21-2-206-217
Views:
1533
Email this article 