Assessment of effectiveness gait menagement with complex physical treatment in rehabilitation after stroke

Uvod: Uspostavljanje i poboljšanje funkcije hoda predstavlja jedan od glavnih ciljeva rehabilitacije bolesnika posle moždanog udara. Osposobljavanje za hod je osnov za postizanje nezavisnosti kako u aktivnostima samozbrinjavanja i dnevnog života, tako i za socijalnu reintegraciju ovih osoba. Savremeni pristup u rehabilitaciji hoda bolesnika posle MU može predstavljati primenu jednog ili češće kombinaciju više različitih terapijskih modaliteta. Konvencionalne i neurofacilitatorne tehnike se sve više kombinuju sa tehanikama koje podrazumevaju primenu intenzivnog, na motorni zadatak orjentisanog pokreta sa mogućnošću velikog broja ponavljanja tokom treninga. Noviji terapijski pristupi u rehabilitaciji bolesnika posle MU zasnivaju se na rezultatima dobijenim eksperimentalnim istraživanjima koje dovode u vezu oporavak funkcije sa konceptom motornog učenja i adaptivnog plasticiteta mozga. Poslednjih godina je pokazano da je terapija uspešna ako omogućuje treniranje pokreta, u ovom slučaju hoda, pri kome su sekvence hoda slične sekvencama karakterističnim za hod osoba bez motornih deficita. Da bi se omogućilo vežbanje, razvijeni su sistemi koji omogućuju kontrolu balansa i delimično rasterećenje pri hodu. Sistem koji je dostupan za terapijski rad se zove Walkaround, i omogućuje kretanje bez potrebe za dodatnim pomagalima (razboj, štapovi, fizička podrška terapeuta). Walkaround je električno vođeno pomagalo pri kome je pacijentu osigurano da ne može da padne, a postoji i pojas koji održava gornji deo tela u položaju pogodnom za vežbanje hodanja različitim brzinama. Cilj rada je da se istraži i pokaže neposredni i dugoročni uticaj složenog fizikalnog tretmana, koji uključuje primenu funkcionalne električne terapije (FET) i posturalne podrške telu (Walkaround), na funkcionalno stanje hoda bolesnika posle moždanog udara. Pacijenti i metod: Istraživanjem su praćeni bolesnici koji su bili na ambulantnom i intrahospitalnom rehabilitacionom tretmanu. Istreživanje je sprovedeno na Klinici za rehabilitaciju "Dr Miroslav Zotović" u Beogradu u saradnji sa Elektrotehničkim fakultetom Univerziteta u Beogradu...Background: Establishing and improving function of gait is one of the most important goals in rehabilitation of patients after stroke. Enabling for walking is basic for achieving independency in activities of daily living and self-management as well as in social reintegration of those patients. Modern approach in rehabilitation of gait in patients after stroke can be one or more often combination of several different therapeutic modalities. Conventional and neurofacilitation techniques are often combined with techniques of intensive motor-oriented moves with ability for large number of repeats during training. New therapeutic approaches in rehabilitation patients with stroke are based on results gathered through experimental researches that connect function recovery with concept of motor learning and adaptive brain plasticity. In recent period, it was shown that the therapy is successful if it enables move, or gait, training, during which walking sequences are similar to those of healthy subjects. To enable training, systems with balance control and partial body weight support were developed. One of them, used for therapeutic work, is called Walkaround, and it enables moving without additional help (parallel bars, canes, and help of therapist). Walkaround is electric driven device where patient is secured from falling, and also there is a belt for upper body part to maintain position suitable for walk practicing in different speed. The aim of the work is to investigate short and long term impact of complex physical training, which includes functional electrical therapy (FET) and body postural support (Walkaround), to walking ability in patients after stroke. Patients and methods: In and out patients during rehabilitation treatments were included in this study. It took place at Clinic for rehabilitation „Dr Miroslav Zotović“ in Belgrade with support of Faculty of Electrical Engineering, University of Belgrade. Ninety adult subjects were included with dg of brain stroke. Two different.