[Correction of gait stereotype and reduction of the risk of falling in patients with equinovarus foot placement and central hemiparesis]

OBJECTIVE

To test a new approach to gait stereotype correction for patients with central hemiparesis with talipes equinovarus.

MATERIAL AND METHODS

The study was performed in a group of patients with formed talipes equinovarus and post-stroke hemiparesis. Footwear with orthopaedic elements was offered to the patients. Evaluation of spatial and temporal gait parameters was performed and the risk of falls was assessed.

RESULTS

In the process of work, data were obtained confirming the effectiveness of using specialized shoes for equinovarus foot placement. The risk of falling significantly decreased when walking; walking became more symmetrical due to an increase in the anterior extension of the paretic limb.

CONCLUSION

Application of this method does not decrease the tone in the paretic limb but optimises the gait stereotype, facilitates the increases of its velocity and decreases the risk of falling.

[The state of cognitive functions in patients with coronavirus infection in the acute period of the disease (outbreaks in 2020-2022)]

OBJECTIVE

To assess the state of cognitive functions in patients in the acute period of coronavirus infection with pneumonia during periods of hospitalization in 2020-2022.

MATERIAL AND METHODS

The study included 3 groups of people of different ages. The first and second groups are inpatients in the acute period of coronavirus infection with viral pneumonia during treatment in a hospital in Krasnoyarsk. Group 1 was hospitalized in the period December 2020 - March 2021. The second group was hospitalized in the period November 2021 - January 2022. The control group consisted of clinically healthy individuals. MMSE, MoCA, FAB, CDT were used to assess the neuropsychological status. Anxiety and depression were assessed using HADS. Patients in the groups were tested on the first day after stabilization of the condition, then again for discharge or transfer to another hospital. The control group was tested once.

RESULTS

Statically significant cognitive impairments were detected in patients with coronavirus infection with viral pneumonia in the acute period of the disease, both at admission and at discharge, compared with the control group. Patients admitted for the period December 2020 - March 2021 had more pronounced cognitive impairment than patients admitted for the period November 2021 - January 2022. Anxiety and depression were not detected on HADS.

CONCLUSION

Coronavirus infection with viral pneumonia causes cognitive impairment in patients in the acute period of the disease. The severity of changes of cognitive functions was different depending on outbreaks of infection, which may probably be due to a mutation of the virus for the period 2020-2022.

[Dynamics of cognitive impairments during L-dopa therapy in Parkinson's disease]

OBJECTIVE

To assess the dynamics of cognitive impairments (CI) in patients with Parkinson's disease (PD) during L-dopa therapy.

MATERIAL AND METHODS

The randomized clinical study included 41 patients with a refined diagnosis of PD 2.5-3.5 stages by Hoehn-Yahr scale, mainly with akinetic-rigid and mixed forms, and with CI associated with PD. All patients were on levodopa therapy. The average duration of the disease was 5 years. The study participants were randomized into two groups according to the design. To assess the dynamics of CI, a neuropsychological study was carried out twice with an interval of 6 months: in group I - at the «peak and outcome» of L-DOPA therapy, and in group II - at the «outcome and peak» of levodopa therapy, respectively. Assessment of cognitive functions (CF) was carried out using Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog), Geriatric Depression Scale (GDS).

RESULTS

The statistically significant improvement of CF at the «peak» of levodopa drugs and the deterioration at the «outcome» of L-DOPA therapy in the form of an increase in CI (p<0.05) was revealed.

CONCLUSION

CI in PD, in a certain extent, may be dependent on L-DOPA therapy as well as motor manifestations. The most dependent on L-DOPA therapy CF were attention, speech, executive and visual-spatial functions.

[Sensory test for fine motor skills of the hand - a pilot study]

The consequences of acute disorders of cerebral circulation significantly reduce the patient's life quality. According to official data, movement disorders are observed in 81.2% of surviving patients. Before and after rehabilitation, it is necessary to determine the degree of motor deficit in the affected hand. Currently used methods, such as video analysis, goniometry, dynamometry, spectrum of clinical scales, etc. have both advantages and disadvantages.

OBJECTIVE

Conduct approbation of the «Method of rehabilitation assessment of fine motor function of the hand using a touch panel» and evaluate its diagnostic significance in the assessment of motor disorders.

MATERIAL AND METHODS

The patients with the syndrome of mild and moderate hemiparesis in the recovery period of stroke, who are at the outpatient stage of rehabilitation, have been examined. The examination was carried out according to the standards of management of the recovery period of stroke, as well as using the author's method.

RESULTS AND CONCLUSION

The tested «Method of rehabilitation assessment of fine motor function of the hand using a touch panel» showed reliability and statistical significance in comparison with clinical scales and can be integrated into the protocols of outpatient and remote rehabilitation.

[Association of rs3025058 polymorphism with the development of stroke in patients with cardiovascular pathology]

AIM

To study the association of single-nucleotide polymorphismrs3025058(5а/6а) with the development of stroke in patients of the East Siberian population with cardiovascular pathology and risk factors for its development.

MATERIALS AND METHODS

The study involved 260 patients with stroke (age [57.0; 51.062.0]) and 272 patients of the control group (age [55.0; 51.062.0]). Among the patients who underwent stroke, 157 men and 103 women. The control group included 170 men and 102 women. The examination of the main group included: collection of complaints, anamnesis, clinical examination, computed tomography of the brain, electrocardiography, echocardioscopy, ultrasound duplex scanning of the extracranial brachiocephalic arteries, 24-hour monitoring of blood pressure and heart rate, analysis of the blood coagulation system. The patients of the main group had the following cardiovascular pathology and risk factors: arterial hypertension, paroxysmal supraventricular tachycardias, dyslipidemia, atherosclerosis of extracranial brachiocephalic arteries, disorders of the hemostasis system. The control group was examined within the framework of the international project HAPIEE. Molecular genetic research was carried out by real-time PCR. Statistical processing of the material was carried out using the Statistica for Windows 7.0, Excel and SPSS 22 application software.

RESULTS

The study established statistically significant associations between the 5a/5a genotype and the 5a allele and stroke in the general group of patients, as well as in the subgroup of men, subgroups of patients with extracranial brachiocephalic arteries atherosclerosis and dyslipidemia. In the subgroup of patients with cardiac arrhythmias, statistically significant results were obtained only for allele 5a, and in the subgroup of women with stroke, subgroups of patients with arterial hypertension and hypercoagulation, no significant associations ofrs3025058(5a/6a) polymorphism with stroke were found.

CONCLUSION

Genotype 5a/5a and allele 5a of the single-nucleotide polymorphismrs3025058(5а/6а) increase the risk of stroke in individuals from the East Siberian population, including those in the presence of such risk factors as extracranial brachiocephalic arteries atherosclerosis and dyslipidemia.

Effectiveness of multidisciplinary team as a new model of after stroke patients’ rehabilitation

Modern papers on treatment and rehabilitation of stroke patients describe the advantages and effectiveness of certain medical rehabilitation types, but these data are not enough to evaluate the efficiency of the whole rehabilitation system. The study was aimed to investigate the potential of the patient-centered problem-oriented multidisciplinary three-stage system for medical rehabilitation of stroke patients. Thestudyincluded 1021 patientsover 18 affected with ischemic or hemorrhagic stroke in the acute phase. All patients had a disability of admission at the time (but no persisting disability in their history). Two models of rehabilitation measures were compared in two consecutive phases of the study. The linear model of rehabilitation assistance was mainly implemented in phase 1, and the multidisciplinary model was implemented in phase 2. The patients’ condition was evaluated using the Modified Rankin Scale (mRS) at the end of rehabilitation. Comparison of the 1st and 2nd phase results demonstrated that the number of patients with mRS score 0–1 in the 2nd phase was lower by 18%. The proportion of patients with positive dynamics was significantly higher in the 2nd phase than in the 1st phase, (16 and 30% respectively). In the 2nd phase there were significantly more patients who demonstrated improvement by 1–4 (mRS score). Thus, the use of a multidisciplinary model provides a significant benefit compared with a linear rehabilitation model.

[The new approach in the treatment of walking disorders in Parkinson's disease]

AIM

To evaluate the efficacy of a proprietary method based on stimulation of the hindfoot when lifting the foot from the surface of the support and bringing it forward in the treatment of walking disorders in patients with Parkinson's disease (PD).

MATERIAL AND METHODS

The study included 19 patients with walking disorders, akinetic-rigid and mixed form of PD. The stage of the disease on the Hoehn-Yahr scale at the time of the study was 2.56±0,41. During the treatment of walking disorders using the proprietary method, correction of anti-parkinsonian therapy was not carried out. Correction of walking disorders was carried out by using 'activating platforms', which allow mechanical stimulation of the hindfoot at the moment of lifting the foot from the surface of the support. Neurological examination, computer stabilometry (CS), gait function evaluation by means of the LA-1 laser analyzer of kinematic parameters of gait, Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Unified Parkinson's Disease Rating Scale (UPDRS) were used before and after treatment.

RESULTS

A significant decrease in core values of LA-1 and positive dynamics on BBS, DGI, UPDRS was revealed after treatment.

CONCLUSION

The original method based on stimulation of foot lifting from the surface and moving the foot forward, effectively improves the pattern of walking in patients with PD and can be recommended as a non-pharmacological method of treatment of impaired walking at the third stage of PD.

Association of rs556621 Polymorphism with Development of Stroke in Patients with Cardiovascular Pathology

Aim. To study the association of single nucleotide polymorphism rs556621 (G> T) with development of stroke in patients of the East Siberian population with cardiovascular pathology and risk factors.

Material and methods. The study involved 260 patients (157 men and 103 women) with stroke (mean age 57.0 [51.0-62.0]) and 272 patients (170 men and 102 women) of the control group (mean age 55.0 [51.0-62.0]). The examination of the main group included: collection of complaints, anamnesis, clinical examination, computed tomography of the brain, electrocardiography, echocardioscopy, ultrasound duplex scanning of extracranial brachiocephalic arteries, daily blood pressure and heart rate monitoring, analysis of the blood coagulation system. The patients of the main group have arterial hypertension, paroxysmal supraventricular tachycardias, dyslipidemia, atherosclerosis of the brachiocephalic arteries, disorders of the hemostatic system. The control group was studied in the framework of the HAPIEE international project. Molecular genetic research was performed by real-time polymerase chain reaction.

Results. There were no statistically significant differences in the frequencies of genotypes and single nucleotide polymorphism rs556621 alleles (G>T) in the subgroup of patients with stroke and those in the control group. The frequency of the rare TT genotype among patients with stroke was 13.3%±4.16, among healthy individuals – 8.8±3.37% (p=0.1). Gender differences when comparing the frequencies of genotypes and alleles were also not detected (p>0.05). The frequencies of the TT genotype were approximately the same in the subgroup of patients with arterial hypertension (13.1%±4.22) and in the control group (7.4±5.25%; p>0.05). No significant differences were observed in the frequencies of the rare genotype of the studied polymorphism in the subgroup of patients with supraventricular tachycardias (20.0±14.37%), hypercoagulability (15.9±7.64%) and the control group (8.8±3.37%), p>0.05. A statistically significant relationship was found between the rare genotype TT of single nucleotide polymorphism rs556621 (G>T) and the development of stroke in patients with dyslipidemia and atherosclerotic lesions of the coronary arteries (p=0.041; odds ratio 1.86, 95% confidence interval 1.02-3.41).

Conclusion. The genotype of TTs of single nucleotide polymorphism rs556621 (G> T) increases the risk of developing stroke in patients with dyslipidemia and atherosclerosis of the brachiocephalic arteries compared with carriers of the GG and GT genotypes. The obtained data are recommended to be considered when prescribing lipid-lowering and antithrombotic therapy. 

[Projects of distant rehabilitation in neurology. The website of in-home rehabilitation in the territory of Krasnoyarsk Region]

At the present time, distant rehabilitation is a relevant direction in restorative medicine. The article considers existing projects in remote rehabilitation, including a self-rehabilitation method developed by academician K.V. Lyadov, the Guided Self-Rehabilitation Contracts system (GSC) etc. The authors present an original project of a remote rehabilitation website 'NeuroHouse' designed for the restoration of balance and gait functions, wrist fine motor skills and speech, spasticity management in patients with neurological diseases. The project combines proprietary rehabilitation methods and classical exercise therapy. This website will make it possible to implement the third ambulatory stage of medical rehabilitation at home.

[Assessment of walking function in neurological practice]

An accurate diagnosis of the existing defect of motor function in patients with neurological pathology is necessary for the optimal formulation of the rehabilitation program, selection of drug therapy and evaluation of the effectiveness of treatment. In current clinical practice, clinical scales such as the Dynamic Gait Index, the Rivermid Mobility Index, the Hauser Walk Index, the Stand Up and Go Test, the MDS-UPDRS III are used most often to assess walking function. Evaluation of walking function using valid scales is very accessible, however, it has such a disadvantage as subjectivity. That's why the study of motor functions by instrumental methods gains more prominence. The most well-known methods of objective walking assessment include an analysis of human movements using accelerometers, three-dimensional video analysis, sub-metric, goniometric and impregnation methods. Each of these methods has both advantages and disadvantages. The main requirement to objective methods of assessing walking functions in neurological pathology is the universality of the complex (the accuracy of measurements, regardless of the type of walking disorder), the ability to determine both temporal and spatial characteristics of the step, the ease of use. Considering these requirements, the use of the 'Induction Analyzer of the kinematic parameters of walking' seems promising in the diagnosis of motor disorders.

[Efficacy, tolerability and safety of the treatment with teberif: the results of a 2-year randomized clinical trial of treatment naïve patients with remitting multiple sclerosis, who have not received DMT, after switching from other interferon β-1a]

OBJECTIVES

To evaluate efficacy, safety, and tolerability of the treatment with teberif/interferon β-1a, to analyze safety, tolerability and dynamics of key efficacy variables after switching from referent drug rebif to biosimilar teberif in patients with remitting multiple sclerosis (RMS).

MATERIAL AND METHODS

During the main period of the international multicenter randomized study patients were randomized to receive treatment with teberif for 52 weeks, or rebif for 52 weeks, or placebo for 16 weeks to evaluate efficacy and safety of treatment. After the main study period, patients were group-independently switched to take open-label teberif treatment during the next 48 weeks.

RESULTS AND CONCLUSION

The analysis of multiple evaluation parameters of the efficiency during the 1st study period (blinded) and the 2^nd study period (open-label) has shown that teberif and rebif demonstrate equivalent efficacy and stable 2-year efficacy of teberif was proven. There were no significant differences between teberif and rebif for all safety, and tolerability parameters. Switching from rebif to teberif didn't influence treatment efficacy. The 2-year study results confirmed a biosimilar teberif's benign tolerability and expected safety profile to other interferons β-1a in patients with RMS.

Differences in the Incidence of Major Risk Factors in Patients with Ischemic or Hemorrhagic Stroke in the Siberian Population

Background. The study of the incidence of risk factors (RF) of stroke for primary and secondary prevention of this disease remains relevant. There are modifiable and non-modifiable RF.

Aim. To study the frequency of the main RF in patients with ischemic and hemorrhagic stroke in the urban population of Krasnoyarsk (Eastern Siberia).

Material and methods. Examination of 124 patients with an ischemic stroke and 28 with hemorrhagic was performed. Patients received treatment in neurologic center of Krasnoyarsk in 2014 year. The main criterion of inclusion was the confirmed diagnosis of an ischemic or hemorrhagic stroke. All patient had the clinic-tool and neurovisualizing examination and collecting the individual and family anamnesis with examination of modifiable and non-modifiable RF. The research of the neurologic status at patients both with ischemic, and with a hemorrhagic stroke was conducted by the standard technique. Based on results of computer or magnetic resonance imaging of a brain the diagnosis of an ischemic or hemorrhagic stroke was established.

Results. A distinctive feature of patients with hemorrhagic stroke was the occurrence of a vascular accident in younger age (6 years earlier) in comparison with ischemic stroke. Among patients with ischemic stroke elevated body mass index (BMI) was in 87 (70.2%) patients, burdened heredity was in 8.1% of cases, and 43.5% of patients were smokers. Among patients with hemorrhagic stroke 16 (57.1%) patients had elevated BMI. People with burdened heredity were not identified among them. Smoking was found in 22 (78.6%) patients in this group.

Conclusion. Improvement of treatment and prevention of an ischemic stroke are in many respects connected with clarification of RF and pathogenic mechanisms of its development. The rational pharmacotherapy directed to pointed impact on individual RF can reduce the risk of development of stroke not only at individual, but also at the population level.

[The optimization of restoration approaches of advanced hand activity using the sensorial glove and the mCIMT method]

AIM

To reason the choice of methods of restoration of advanced hand activity depending on severity of motor disturbance in the top extremity.

MATERIAL AND METHODS

Eighty-eight patients were randomized into 3 groups: 1) the mCIMT group, 2) the 'touch glove' group, 3) the control group. For assessment of physical activity of the top extremity Fugl-Meyer Assessment Upper Extremity, Nine-Hole Peg Test, Motor Assessment Scale were used. Assessment of non-use phenomenon was carried out with the Motor Activity Log scale.

RESULTS AND CONCLUSION

At a stage of severe motor dysfunction, there was a restoration of proximal departments of a hand in all groups, neither method was superior to the other. In case of moderate severity of motor deficiency of the upper extremity the most effective was the method based on the principle of biological feedback - 'a touch glove'. In the group with mild severity of motor dysfunction, the best recovery was achieved in the mCIMT group.

[A comparative clinical study of the efficacy of computer cognitive training in patients with post-stroke cognitive impairments]

AIM

To assess the effectiveness of neuropsychological computer programs in comparison with entertainment computer games.

MATERIAL AND METHODS

Patients (n=68), aged 40-65 years, were randomized into three groups: an intervention group (neuropsychological computer programs), an active control group (entertaining computer games), a passive control group (conventional treatment).

RESULTS

An analysis of the coefficient of effectiveness showed significant improvements in the intervention group comparing with the passive control group (MoCA, MMSE, Schulte test) and the active control group (MoCA).

CONCLUSION

Neuropsychological computer programs confirmed their effectiveness for recovery of post stroke cognitive impairments comparing with conventional treatment and entertainment computer games as well.

[A comparative placebo-controlled clinical study on the efficacy and safety of interferon beta-1a for subcutaneous injections in patients with remitting multiple sclerosis: results of the first year of observations]

AIM

To prove the equivalent efficacy of teberif (BCD-033, interferon beta-1) and rebif (interferon beta-1a) in patients with remitting multiple sclerosis (RMS).

MATERIAL AND METHODS

A multicenter double blind placebo-controlled comparative randomized III phase study included 163 patients with RMS. Patients were randomized into three equal groups (teberif, rebif or placebo).

RESULTS AND CONCLUSION

After 52 weeks, the equivalent efficacy of teberif and the brand drug rebif was shown. The result of assessment of the primary endpoint, which was combined unique active (CUA) lesion (the total of MRI T1-weighted lesions and new or newly enlarging T2-weighted lesions, without double counting of lesions with both activities), showed no significant differences (0.727±1.042 and 0.652±1.059 (p=0.7354, t-Student test) in the teberif and rebif groups, respectively. No between-group differences were found for other MRI indices and clinical parameters related with relapses. Teberif was shown to have a favorable safety and tolerability profile comparable to that of rebif. The results suggest the therapeutic equivalency of the drugs and form the basis for using the bioanalogue of interferon-beta 1 in patients with RMS.

[The application of the Multi-Touch pad for the evaluation of the fine motor activity of the wrist]

AIM

The objective of the present study was to elaborate the method for the evaluation of the fine motor activity of the wrist in the patients presenting with wrist movement disorders resulting from central hemiparesis and to demonstratee the reliability of such method through the calculation of the standard error of measurements and minimal the detectable change (MDC95%).

MATERIAL AND METHODS

The study population was comprised of 42 patients who had undergone ischaemic stroke and suffered from the impairment of the upper limb functions . The deficit of the fine motor skills was estimated with the use of the original multi-touch diagnostic technique. The results of the assessment were compared with those of the measurement of upper limb motor activity based on the validated scales, such as the Fugl-Meyer Assessment (FMA) scale and the Nine Hole Peg Test (PHT).

RESULTS

The study with the application of the multi-touch method for diagnostics of the fine motor skills has demonstrated the high internal consistency of the measurements, with the Cronbach's Alpha Reliability Coefficient amounting to 0.98. The re-test reliability was high, with the ICC=0.98 (95% CI 0.97-0.99). The Spearman rank-order correlation with the locomotion scale estimates gave evidence of the good associative links, with the Fugl-Meyer Assessment scale correlation coefficient making 0.55-0.66 and the Nine Hole Peg Test findings being -0.7. The Minimal Detectable Change (MDC95%) for the multi-touch method was found to be 12.67%.

CONCLUSION

The objective diagnostics of the fine motor skill disturbances with the use of the original multi-touch method has demonstrated its high reliability and a high degree of correlation with the estimates obtained with the application of the modern validated scales in the patients who had undergone ischaemic stroke. Therefore, this method can be recommended for clinical use.

[Correction of postoperative cognitive dysfunction in cardiosurgery using computer-based stimulation programs]

AIM

To evaluate the efficacy of computer-based stimulation programs in the correction of postoperative cognitive dysfunction in patients with ischemic heart disease in remote period after coronary artery bypass surgery.

MATERIAL AND METHODS

The study involved 74 patients. All patients underwent a drug therapy and the rehabilitation course using computer-based stimulation programs (1 time per day for 20 minutes during10 days). Coronary artery bypass surgery was performed for all patients. Patients were examined before operation, after 6 and 12 months.

RESULTS

The significant improvement of higher cortical functions assessed with the FAB scale, the Schulte test, associated thinking test, ten-word retrieval test at the first attempt, the Clock drawing test) was revealed in the group using computer-based stimulation programs in comparison with the control group.

CONCLUSION

It is found that rehabilitation course using computer-based stimulation programs in patients with ischemic heart disease after coronary artery bypass surgery is the effective method of cognitive function correction.

[Evaluation of a method based on the principle of CI therapy in the correction of walking function in patients with post-stroke hemiparesis syndrome]

AIM

To develop a new, effective, affordable method of neurorehabilitation for the correction of walking functions based on the principle of CI (constraint-induced movement therapy) therapy in patients with the syndrome of hemiparesis of post-stroke origin.

MATERIAL AND METHODS

The study included 100 patients with moderate to marked syndrome of central hemiparesis in the recovery period of stroke. Patients were randomized into two groups. In the main group, the walk recovery was carried out using CI-therapy in complex with traditional methods of neurorehabilitation and in the comparison group, walk correction was performed by generally accepted methods of kinesiotherapy and physical therapy. Both groups were comparable by stage of stroke, the severity of paresis, age.

RESULTS AND CONCLUSION

The risk of fall significantly decreased in both groups of patients. The length and paretic step time significantly decreased in the main group. The effectiveness of the restoration of the function of walking was higher in the main group that allows us to recommend the method of correction of the walk based on the principle of CI therapy in the complex neurorehabilitation.

[The investigation of kinematic features of gait in healthy subjects and patients with post-stroke atactic disorders]

AIM

To study spatial/temporal parameters of gait in post-stroke vestibular-atactic syndrome.

MATERIAL AND METHODS

Authors investigated the speed, rhythmic and angle parameters of the gait in healthy subjects (n=15) and in patients with atactic disorders in the recovery period of vertebrobasillar ischemic stroke (n=15). Physical examination with elements of anthropometry, clinical assessment of gait function with the Dynamic Gait Index, objective assessment of gait parameters using the system for 3D movement video analysis VICON Motion Capture Systems were used.

RESULTS

There were a statistically significant decrease in the speed and pace of the gait, increase in the step duration and duration of the double support phase. The speed and rhythmic parameters of the left and right lower limb differed significantly. A delay of the moments of foot lifting from the surface was observed. Authors also revealed a decrease in the amplitude of flexion and extension in all segments of the lower limbs in the double step phase.

CONCLUSION

These characteristics represent the activation of the «sitting» strategy and facilitate the objective assessment of the hyperfunction of the reactive postural synergies in patients with post-stroke atactic disorders.

[The results of the multicenter pharmaco-epidemiological observational project on the use of mydocalm in the treatment of pain syndromes with the muscle spasm]

The prospective multicenter open noncomparative pharmaco-epidemiological observational project on the use of mydocalm in real clinical practice has been completed in 2013. The project has been performed in 2090 clinical/rehabilitation settings in 284 cities of 13 countries using the results of 35,383 patients. The project aimed to assess the safety of treatment (percentage of patients with adverse-effects) and pain relieving efficacy as well as patient's satisfaction with the treatment. In total, 6603 (19%) adverse-effects were recorded. Their severity was evaluated as mild in 84,48%, no serious adverse-effects were noted. The high efficacy of mydocalm in the treatment of pain syndromes with the muscle spasm has been demonstrated. The high level of tolerability and absence of the clinically significant increase of adverse effects in the combination with nonsteroidal anti-inflammatory drugs have been confirmed.

[Changes in structural and functional plasticity of the brain induced by environmental enrichment]

The review contains current data on structural and functional brain plasticity mechanisms under the enriched environment. Enriched environment contains social and non-social stimuli acting on different aspects of the development and functioning of the brain. Special attention is devoted to the modeling of enriched environment in the experiment. Enriched environment implies the action of social stimuli, new objects, therefore the enriched environment in animals can be considered as an adequate model to study changes in brain structure and function in people during learning or acquiring complex skills. The review describes the theory of enriched environment's influence on neurogenesis, the neuron-glia relationships, and the impact of enriched environment on damaged brain as well as the possibilities of using the paradigm of enriched envimronmentfor neurorenhabilitation. Molecular mechanisms of synaptic transmission, which has a correlation with the performance of cognitive functions, are the possible target for the action of environmental factors at the brain under (patho)physiological conditions. The considerable progress has been done in understanding the mechanisms that mediate the effects of enriched environment on the brain, but still there are many non-resolved questions in the neurochemistry and neurobiology of this phenomenon. Overall, the experience-induced neuroplasticity is a unique mechanism for the development and recovery of brain functions. It opens new perspectives in neuropharmacology and neurorehabilitation.

[Cognitive disorders and its correction in the acute period of ischemic stroke]

The efficiency of using of original stimulating programs for correction of memory decline, attention impairment and optical-spatial gnosis disorders was evaluated in 100 post stroke patients with the degree of cognitive decline from mild cognitive impairment to mild dementia in the acute period of stroke. In addition to traditional methods of treatment, we applied training using computer programs within 20-30 minutes daily 5 times a week during 14 days. Efficiency of treatment was measured by the MMSE, the FAB, the Clock drawing test, Shulte's tables and a letter correction test. After the treatment, the statistically significant improvement of cognitive functions was found in the group of patients receiving the correction with computer programs.

Neurodynamic speech impairment in poststroke patients: pathogenesis, clinics, diagnostics

The results of study, which devoted by diagnostics of neurodynamic speech disorders on the basis of clinical and computed speech transforming finding were shown. 186 patients in the poststroke period were examined. The possibility of using the method of computed transformation of time parameters of speech for objective registration of speech defeat and establishment of diagnosis of aphasia were revealed.

[The use of stabilizing platforms in the correction of atactic disorders in patients with vertebrobasilar stroke]

Results of the treatment of atactic gait and balance disorders in post-stroke patients are presented. A method of neurorehabilitation using stabilizing platforms based on the excluding ankle joint postural strategy and support square is proposed. The efficacy of this method assessed by the computerized stabilometry and functional balance scale was comparable with the results of the generally accepted computerized dynamic posturography with visual biofeedback.

Use of the principle of proprioceptive correction in the restoration of voluntary movements in the paralyzed arm in patients in the late recovery and residual post-stroke periods

A specially developed proprioceptive correction costume was used for the restoration of motor functions in the proximal parts of the upper limb in central paralysis syndrome in patients in the late recovery and residual post-stroke states. The costume is a logical continuation of the Adeli and Gravistat proprioceptive correction systems, directed to restoring balance and gait in post-stroke patients. The costume consists of a waistcoat and cuffs connected by a system of elastic bands fixed around the shoulder and forearm of the paralyzed upper limb. Controlling the tension in the elastic bands allows a regime of "facilitated" work to be created, with increased loading of active movements in the proximal parts of the paralyzed arm. The effectiveness of using the proprioceptive correction costume in restoring voluntary movements in the upper limb was demonstrated during the treatment of 23 patients in the late recovery and residual post-stroke periods. In most patients, treatment resulted in significant decreases in the extent of paralysis in the arm and produced recovery rates greater than those seen in the control group. Use of the proprioceptive correction costume in the neurorehabilitation complex is advised for restoration of voluntary movements in the arms of stroke patients.

[The use of the proprioceptive correction principle in the restoration of conscious movements in the patient's paretic arm in the late restorative and residual periods of stroke]

A specially designed suit for proprioceptive correction is offered for the restoration of motor functions in the proximal parts of the upper extremity in the central paresis syndrome at the late restorative and residual periods of stroke. The suit is a logical continuation of the proprioceptive correction systems Adeli, Gravistat aimed at the restoration of equilibrium and walking in post-stroke patients. It consists of a waistcoat, cuffs connected with a system of elastics which are fixed around the upper arm and arm of the paretic upper extremity. The regulation of the tension of elastics allows to create the regimes of "facilitated" work and increased exertion during active movements in the proximal parts of a paretic arm. The effectiveness of the use of the proprioceptive correction suit for restoration of conscious movements in the upper extremity has been proved in 23 patients in the late restorative and residual periods of stroke. As a result of the treatment, most of the patients showed reliable reduction of paresis expression in the arm, the rate of restoration exceeded the indexes in the control group. It is expedient to use the proprioceptive correction suit in the complex of neurorehabilitation measures for restoration of conscious movements in an arm of the post-stroke patient.

[A use of betaserc in ataxic syndromes]

Thirty-five patients with vestibular (25) and cerebellar (10) ataxy were medicated by betacerc during 21 days. A status of balance function was estimated, using stabilometric complex MBN "Biomechanika", before and after the treatment course. After the end of the treatment, symptoms of static ataxy and vertigo were reduced. An analysis of stabilogramm has confirmed a tendency to normalization of static balance parameters as a result of betacerc treatment of vestibular and cerebella types of ataxy, with significant decrease of general length of the way, area of support and velocity of gravity center displacement.