Vol 10, No 3 (2016)

Original articles

Virtual reality as an upper limb rehabilitation approach

Khizhnikova A.E., Klochkov A.S., Kotov-Smolenskiy A.M., Suponeva N.A., Chernikova L.A.

Abstract

The consequences of cerebrovascular diseases significantly reduce the quality of life of patients. Recovery of basic motor skills, such as the ability to reach the object, manipulate it, and coordinate the movements of two hands is one of the top-priority tasks in restoring patient’s living and social activity. Training in the environment as close to the real one as possible, active involvement of the patient, as well as interactive feedback, which allows patients to control the correct execution of motor tasks and adjust their own efforts are required for successful motor recovery. The development of computer technology enabled the improvement of conventional approaches to rehabilitation of stroke patients. Virtual reality (VR) is extensively used to meet these conditions and achieve successful targeted training for a specific motor task. The technical basis of VR includes computer modeling and computer simulation, as well as three-dimensional visualization, which provides realistic visualization of movements on the screen. These technologies enable reconstruction of the appropriate working space for motor skill training, and provide interactive feedback and high intensity of rehabilitation. This article provides information about the development of these technologies in the field of motor rehabilitation of upper extremity function, comparative analysis of systems that are currently used or being developed, and prospects of VR development in neurorehabilitation.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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Recovery of static and locomotor functions in patients with the vestibular-atactic syndrome during the recovery from cerebrovascular accident

Kaygorodtseva S.A., Abros'kina M.V., Prokopenko S.V., Ismailova S.B.

Abstract

Background. The article presents the results of the research on the effectiveness of the proprietary method of the locomotor function correction by activating the vestibular analyzer using the vertical oscillation procedure in patients with postapoplectic vestibular-atactic syndrome.
Methods. The study involved 47 patients, median age was 58 [51; 63] years. The patients were randomized into 2 groups. In the main (I) group (n=23), patients received complex rehabilitation treatment and the proprietary method of balance and gait correction. The originality of the method lies in activation of the vestibular analyzer and postural synergies through displacements of the center of gravity in the vertical plane. In the comparison group (II), patients (n=24) received complex rehabilitation treatment and training on biofeedback (BFB) platforms. Computer stabilometry (CS), assessment of gait function using of the proprietary method “Laser analyzer of kinematic gait parameters” (LA-1), Berg Balance scale (BBS), Dynamic Gait Index (DGI), International Cooperative Ataxia Rating Scale (ICARS), Falls Efficacy Scale (FES), and HADS were carried out before and after the course of treatment.
Results. In group I, statistically significant change in CS, LA-1, BBS, DGI, and ICARS score was observed after training course. In group II, significant changes in CS, LA-1, BBS, and DGI scores were also observed. When comparing the data of CS, BBS, and DGI, no statistically significant differences were found between groups I and II.
Conclusion. The effectiveness of the proprietary method in restoring balance and gait in postinsult patients was demonstrated to be comparable to that of training on BFB platforms.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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Quality of life in patients with transluminal balloon angioplasty and stenting of the vertebral arteries

Maksimova M.Y., Sermagambetova Z.N., Skrylev S.I., Koshcheev, A.Y., Shchipakin V.L., Sinitsy I.A.

Abstract

Introduction. Over a relatively short period, interventional technologies have become an integral part of angioneurology. One of the criteria for evaluating the efficacy of surgical treatment is quality of life, which is an integral indicator of overall health.
Objective. The study purpose was to investigate quality of life in patients who underwent transluminal balloon angioplasty with vertebral artery stenting.
Materials and methods. The study involved 50 patients with hemodynamically significant stenoses of the extracranial part of the vertebral arteries, who underwent transluminal balloon angioplasty with vertebral artery stenting. A SF-36 questionnaire was used to evaluate quality of life.
Results. Before vertebral artery stenting, low quality-of-life indicators were observed in a cohort of patients included in the study. The quality-of-life indicators associated with the physical and psychological conditions improved in the patients 6 months after vertebral artery stenting.
Conclusion. Quality of life is an independent objective multifactor indicator reflecting surgical treatment outcomes.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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Changes in the MRI brain picture associated with newly diagnosed asymptomatic arterial hypertension

Dobrynina L.A., Gnedovskaya E.V., Sergeeva A.N., Krotenkova M.V., Piradov M.A.

Abstract

ntroduction. Arterial hypertension (AH) is the major modified risk factor for brain injury. Clarification of the brain changes and the mechanisms of their development during the asymptomatic stage will ensure better results in the prevention of AH complications.
Objective. The study purpose was to evaluate specific changes in the brain MRI picture, associated with AH of varying severity.
Materials and methods. The study involved 82 patients with newly diagnosed asymptomatic AH, aged 45–59 years. The patients underwent MRI of the brain (T1 and T2 weighted images, FLAIR, diffusion weighted imaging with calculation of an apparent diffusion coefficient (ADC) map). We evaluated the localization and severity of white matter hyperintensity (WMH), lacunar infarcts, and dilated perivascular spaces as well as the white matter microstructure based on ADC in a visually intact white matter in areas of its potential vulnerability.
Results. The earliest and most typical change is the formation of hyperintensity lesions in the juxtacortical areas of the frontal lobes. AH worsening is associated with an increase in the number of hyperintensity lesions from the frontal to occipital areas of the white brain matter and from the surface to deep brain regions as well as microstructural changes in the intact white matter in potential vulnerability areas.
Conclusion. The observed high correlations between WMH and dilated semioval perivascular spaces and increased diffusion in the intact white matter as well as the absence of similar correlations for lacunar infarcts suggest that the pathophysiological basis of early brain changes in AH is increased vascular permeability, but not ischemia. The factors of a high risk of clinical symptoms include lesion extension to the posterior brain structures, multiple foci of hyperintensity in the periventricular white matter of the frontal lobes, and an increasing number of lacunar infarcts. These findings are significant for evaluating potential risk of clinical symptoms and for understanding the mechanisms of early brain injury in AH.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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Subclinical cerebral manifestations and changes of brain associated with newly diagnosed asymptomatic arterial hypertension

Dobrynina L.A., Gnedovskaya E.V., Sergeeva A.N., Krotenkova M.V., Piradov M.A.

Abstract

Background. Progressive aggravation of cerebral affection in patients with asymptomatic arterial hypertension (AH) suggests importance of the affection in the development of subclinical cerebral manifestations.
Objective. To evaluate the dependence of subclinical depression, anxiety, and memory impairments on the severity of white matter hyperintensity (WMH) and microstructural changes in a visually intact brain matter in patients with asymptomatic AH.
Materials and methods. The study involved 82 patients with newly diagnosed asymptomatic AH, aged 40−59 years. All patients were assessed for delayed memory (Luria’s test) as well as depression and anxiety (Hospital Anxiety and Depression Scale (HADS)) and underwent brain MRI (T1 and T2 weighted imaging, FLAIR, diffusion weighted imaging with calculation of apparent diffusion coefficient (ADC) maps).
Results. The earliest structural-functional relationships between subdepressive symptoms and ACD-assessed microstructural changes were found in the hippocampus, thalamus, and visually intact deep white matter of the cerebral hemispheres. AH worsening was accompanied by a growing number of areas associated with subclinical depression, anxiety, and memory impairments and characterized by WMH lesions and an increased ACD in a visually intact brain matter.
Conclusion. Microstructural changes in the hippocampus, thalamus, and deep structures of the hemispheres are the structural/functional basis of subclinical depression at the early AH stages. The AH worsening-associated involvement of new structures associated with subclinical depression, anxiety, and memory impairments, which are characterized by an increased ACD and WMH lesions, demonstrates the importance of progressive diffuse brain damage in the development of both subclinical and subsequent clinical manifestations of depression, anxiety, and memory impairments.The nature of relationships between hypertension and depression needs to be clarified. In this connection, it seems appropriate to study the role of their common stress-induced processes: inflammation and neurovascular association due to hyperactivation of the suprasegmental autonomic centers.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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Morphological and functional assessment of the effect of L-lysine aescinat in rats with experimental ischemia of the spinal cord

Ponomarev G.V., Shmonin A.A., Shumeeva A.G., Aliyev K.T., Vlasov T.D., Mel’nikova E.V., Skoromets A.A.

Abstract

Background. Spinal cord ischemia (SCI) is accompanied by severe persistent neurological and physical disorders. The article discusses potential neuroprotective effect of L-lysine aescinat.
Objective. to assess the effect of L-lysine aescinat on the functional recovery and morphological picture of spinal cord in white rats with simulated SCI.
Methods. Spinal cord ischemia was induced by ligation of the infrarenal abdominal aorta in two experimental groups of rats. In the control group (n=8), aorta was ligated; in the experimental group (n=8), L-lysine aescinat was injected intraperitoneally at a dose of 0.14 mg/kg 30 minutes before ischemia, followed by ligation of aorta.
Results. Pronounced and statistically significant neuroprotective effect of L-lysine aescinat was demonstrated, which clinically manifested as neurological deficit reduction and morphologically manifested as increased number of normochromic neurons and decreased number of shrunken neurons and shadow-cells (p<0.01), as well as suppression of edema of the spinal cord substance.
Conclusion. L-lysine aescinat has a neuroprotective effect in rats with experimental ischemia of the spinal cord.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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The effect of transcranial electrical stimulation of brain endorphinergic mechanisms on the blood β-endorphin level in experimental ischemic stroke and traumatic brain injury

Zanin S.A., Kade A.K., Trofimenko A.I., Baykova E.E., Onopriev V.V.

Abstract

Objective. The study objective was to evaluate the effect of transcranial electrical stimulation (TES therapy) of the brain endorphinergic mechanisms on opioidergic systems in experimental ischemic stroke in rats and in patients with traumatic brain injury (TBI).
Materials and methods. The plasma β-endorphin level was studied in rats with experimental ischemic stroke and in TBI patients in association with TES therapy and without it on days 1, 3, 7, and 14.
Results. The plasma β-endorphin level consistently decreased in groups without TES therapy compared to the control through days 1 to 14. The use of TES therapy, starting the first day of experimental ischemic stroke in rats, promoted consistent growth and stabilization of the β-endorphin concentration at a level higher than the control one during the entire observation period through days 1 to 14. The β-endorphin level in patients with moderate to severe traumatic brain injury remained consistently decreased in association with standard therapy during the entire observation period through days 1 to 14. When applying TES therapy, the β-endorphin concentration was 1.39 times higher compared to that in a group of patients receiving standard treatment only.
Discussion. Further research of the TES therapy effect on the course and outcome of ischemic stroke and traumatic brain injury is required. There is a potential opportunity to include TES therapy in the standards of care for patients in the acute phase of ischemic stroke and for TBI patients.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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New opportunities in the use of endovascular methods of recanalization in the management of ischemic stroke

Kutlubaev M.A., Akhmadeeva L.R.

Abstract

Currently, there is a limited number of treatments for ischemic stroke. Intravenous thrombolytic therapy is the most effective method. However, its efficacy is very low in the case of stroke caused by occlusion of large intracranial arteries. Previous studies of endovascular recanalization methods in the treatment of stroke, particularly randomized controlled trials (RCTs), such as IMS-3, SYNTHESIS Expansion, and MR RESCUE, have shown negative results. The results of other RCTs (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT) published in 2015 have shown that, in the case of careful selection of patients with verified occlusion of large intracranial arteries, endovascular recanalization significantly improves stroke outcomes.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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Status of acute symptomatic attacks in a female patient with thyrotoxicosis: Hashimoto’s encephalopathy. Case report

Tokareva Y.V., Kotov A.S., Semenova E.I., Eliseev Y.V., Romanova M.V., Alakova M.A., Misnikova I.V., Komerdus I.V.

Abstract

Hashimoto’s Encephalopathy is an autoimmune disease associated with significant increase in titer of autoantibodies to thyroid peroxidase and thyroglobulin and characterized by inflammatory and degenerative brain disorders. We report a clinical case of recurrent status of acute symptomatic attacks in a female patient with Hashimoto’s encephalopathy.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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Posterior cortical atrophy as a variant of progressive local brain atrophy

Belopasova A.V., Kadykov A.S., Berdnikovich E.S., Kashina E.M.

Abstract

Posterior cortical atrophy (PCA) is a rare disease that manifests mainly as disturbance of cortical visual function, agnosia. Bálint’s syndrome (optic ataxia) is one of the clearest clinical markers of the disease. The disease is caused by progressive atrophy of the visual cortex. Many researchers define PCA as an independent disease, while others suggest that it is a “posterior” variant of Alzheimer’s disease, corticobasal degeneration, etc. Morphological studies of brain tissues support the neurodegenerative nature of the disease.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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Tension-type headache

Maximova M.Y., Khokhlova T.Y., Piradov M.A.

Abstract

Tension-type headache is the most common form of headache. The article discusses prevalence, basic developmental mechanisms, and clinical aspects of tension-type headache. Tension-type headache is a multifactorial disease. Myofascial mechanisms, central sensitization, and decreased antinociceptive effect are believed to play a leading role in the pathogenesis of the disease.
Annals of Clinical and Experimental Neurology. 2016;10(3):
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