Modern rehabilitation approaches to the correction of post-stroke stato-locomotor disorders: focus on improving functional independence

BACKGROUND: Impaired statolocomotor function and motor stereotypes affect mobility in patients with ischemic stroke. Promising multimodal rehabilitation strategies include programmable functional electrical stimulation (FES) and computerized stabilometric biofeedback training (SBT).

AIM: The aim of the study was to assess the effectiveness of SBT and FES within a comprehensive rehabilitation program in patients with ischemic stroke.

MATERIALS AND METHODS: The study included 160 post-stroke patients divided into four groups (n=40) to receive standard medical and social rehabilitation (MSR), programmable FES, computerized SBT, or their combinations. The main group (MG) received MSR combined with programmable FES and computerized SBT. The first comparison group (CG I) received MSR and computerized SBT, while the second comparison group (CG II) received MSR and programmable FES. In the control group, only MSR was used. Each group underwent 15 treatment sessions.

The MSR course included three assessment visits: at two and five weeks, and at six months. Statolocomotor function was assessed using the Tinetti test, the Berg Balance Scale, and computerized stabilometry. Functional independence was assessed using the Barthel index.

RESULTS: During the MSR course, positive changes were observed in all groups of patients according to the Tinetti test. Nevertheless, MG exhibited statistically significant dynamics in the total motor activity and walking subscale (25.02±0.82 and 11.54±0.14 points, respectively). In CG I, statistically significant improvement was observed in total motor activity and balance subscale (25.28±0.36 and 14.09±0.12 points, respectively). In CG II, improvement was observed in all parameters, including total motor activity (25.12±0.28 points), balance (14.02±0.12 points), and walking (11.10±0.16 points), with these changes being preserved by month 6. The balance function on the Berg Balance Scale exhibited improvement by week 5 in both CG I and CG II. These results were maintained over the long-term period. Computerized stabilometry demonstrated the effectiveness of MSR, with the greatest dynamics observed in the MG. An improvement in functional independence, as measured by the Barthel index, was observed at week 2. This improvement was statistically significant at visits 3 and 4 in the MG, CG I, and CG II (p <0.05). Additionally, an inverse correlation was established between statolocomotor disorders and functional independence (r=0.568, m=±0.024, p ≤0.01).

CONCLUSION: Integrating programmable FES and computerized SBT into rehabilitation programs for patients after stroke supports a multimodal approach to address statolocomotor disorders, thereby enhancing functional independence of these patients.