Preview

Медицинский Совет

Расширенный поиск

Вопросы реабилитации пациентов после инсульта в амбулаторных условиях

https://doi.org/10.21518/2079-701X-2018-12-18-22

Полный текст:

Аннотация

В статье рассмотрены вопросы реабилитации пациентов после инсульта на амбулаторном этапе. Представлены ключевые принципы постинсультной реабилитации: функциональный подход, частота и интенсивность тренировок. Рассмотрены основные методы реабилитации: лечебная физкультура, физиотерапия, лекарственная терапия и др. Определена оптимальная интенсивность и длительность тренировок. Отмечены особенности физической реабилитации паретичной руки. Показана эффективность комплексной реабилитации с использованием физических и медикаментозных методов в восстановлении утраченных функций. Рассмотрено применение препарата Вазобрал в процессе реабилитации пациентов после инсульта.

 

Об авторе

Н. В. Пизова
ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава России
Россия
д.м.н., профессор


Список литературы

1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R. et al. Heart disease and stroke statistics-2017 update: A report from the american heart association. Circulation, 2017,135(10): e146–e603.

2. Elkins JS, Johnston SC. Thirty-year projections for deaths from ischemic stroke in the United States. Stroke, 2003, 34(9): 2109–2112.

3. Veerbeek JM, Kwakkel G, van Wegen EEH, Ket JC, Heymans MW. Early prediction of outcome of activities of daily living after stroke: A systematic review. Stroke, 2011, 42(5): 1482–1488.

4. Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke, 2005, 36: 1330–1340.

5. Kauhanen M, Korpelainen JT, Hiltunen P, Brusin E, Mononen H, Määttä R. et al. Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke, 1999, 30: 1875–1880.

6. Aström M, Adolfsson R, Asplund K. Major depression in stroke patients. A 3-year longitudinal study. Stroke, 1993, 24: 976–982.

7. Kuvalekar K, Kamath R, Ashok L, Shetty B, Mayya S, Chandrasekaran V. Quality of life among persons with physical disability in Udupi Taluk: a cross sectional study. J Family Med Prim Care, 2015, 4: 69–73.

8. Denti L, Agosti M, Franceschini M. Outcome predictors of rehabilitation for first stroke in the elderly. Eur J Phys Rehabil Med, 2008, 44: 3–11.

9. Koh GC, Chen C, Cheong A, Choo TB, Pui CK, Phoon FN. et al. Trade-offs between effectiveness and efficiency in stroke rehabilitation. Int J Stroke, 2012, 7: 606–614.

10. Shah S, Vanclay F, Cooper B. Efficiency, effectiveness, and duration of stroke rehabilitation. Stroke, 1990, 21: 241–246.

11. Micieli G, Cavallini A, Quaglini S, Guideline Application for Decision Making in Ischemic Stroke (GLADIS) Study Group: Guideline compliance improves stroke outcome: a preliminary study in 4 districts in the Italian region of Lombardia. Stroke, 2002, 33: 1341–1347.

12. Ullberg T, Zia E, Petersson J, Norrving B. Changes in functional outcome over the first year after stroke: an observational study from the Swedish stroke register. Stroke, 2015, 46(2): 389-94.

13. Pettersen R, Dahl T, Wyller TB. Prediction of long-term functional outcome after stroke rehabilitation. Clinical Rehabilitation, 2002, 16(2): 149-59.

14. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC. et al. American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2016, 47: e98–169.

15. Prvu Bettger JA, Kaltenbach L, Reeves MJ, Smith EE, Fonarow GC, Schwamm LH et al. Assessing stroke patients for rehabilitation during the acute hospitalization: findings from the get with the guidelines-stroke program. Arch Phys Med Rehabil, 2013, 94: 38–45.

16. Iyer M, Bhavsar GP, Bennett KJ, Probst JC. Disparities in home health service providers among Medicare beneficiaries with stroke. Home Health Care Serv Q, 2016, 35: 25–38.

17. Skolarus LE, Feng C, Burke JF. No racial difference in rehabilitation therapy across all post-acute care settings in the year following a stroke. Stroke, 2017, 48: 3329–35.

18. Dewey HM, Sherry LJ, Collier JM. Stroke rehabilitation 2007: what should it be? Int J Stroke, 2007, 2: 191-200.

19. Smith LN, James R, Barber M, the Guideline Development Group. Rehabilitation of patients with stroke: summary of SIGN guidance. BMJ, 2010, 340: c2845.

20. Khedr EM, Ahmed MA, Fathy N, Rothwell JC. Therapeutic trial of repetitive transcranial magnetic stimulation after acute ischemic stroke. Neurology, 2005, 65(3): 466-468.

21. Mansur CG, Fregni F, Boggio PS, Riberto M, Gallucci-Neto J, Santos CM. et al. A sham stimulation-controlled trial of rTMS of the unaffected hemisphere in stroke patients. Neurology, 2005, 64(10): 1802-1804.

22. Scheidtmann K., Fries W., Muller F., Koenig E. Effect of levodopa in combination with physiotherapy on functional motor recovery after stroke: A prospective, randomised, double-blind study. Lancet, 2001, 358(9284): 787-790.

23. Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D. et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA, 2006, 296(17): 2095-2104.

24. Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke, 1995, 26(6): 982-989.

25. Dobkin BH. Clinical practice. Rehabilitation after stroke. N Engl J Med, 2005, 352(16): 1677-1684.

26. Krakauer JW. Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol, 2006, 19(1): 84-90.

27. Belda-Lois J, Mena-del Horno S, Bermejo-Bosch I, Moreno JC, Pons JL, Farina D. et al. Rehabilitation of gait after stroke: a review towards a top-down approach. J Neuroeng Rehabil, 2011, 13(8): 66.

28. Pennycott A, Wyss D, Vallery H, Klamroth-Marganska V, Riener R. Towards more effective robotic gait training for stroke rehabilitation: a review. J Neuroeng Rehabil, 2012, 9: 65.

29. Mehrholz J, Pohl M, Elsner B. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev, 2014, 23(1): CD002840.

30. States RA, Salem Y, Pappas E. Overground gait training for individuals with chronic stroke: a Cochrane systematic review. J Neurol Phys Ther, 2009, 33(4): 179-186.

31. French B, Thomas L, Leathley M, Sutton C, McAdam J, Forster A. et al. Does repetitive task training improve functional activity after stroke? A Cochrane systematic review and meta-analysis. Journal of Rehabilitation Medicine, 2010, 42(1): 9-14.

32. Galvin R, Cusack T, Stokes E. A randomised controlled trial evaluating family mediated exercise (FAME) therapy following stroke. BMC Neurology, 2008, 20(8): 22.

33. Kwakkel G, van Peppen R, Wagenaar RC, Wood Dauphinee S, Richards C, Ashburn A, et al. Effects of augmented exercise therapy time after stroke: a meta-analysis. Stroke, 2004, 35(11): 2529-39.

34. Kwakkel G. Impact of intensity of practice after stroke: issues for consideration. Disability and Rehabilitation, 2006, 28(13-14): 823-30.

35. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet, 2011, 377(9778): 1693-702.

36. Lohse KR, Lang CE, Boyd LA. Is more better? Using metadata to explore dose-response relationships in stroke rehabilitation. Stroke, 2014, 45(7): 2053-58.

37. Veerbeek JM, Koolstra M, Ket JC, van Wegen EE, Kwakkel G. Effects of augmented exercise therapy on outcome of gait and gait-related activities in the first 6 months after stroke: a meta-analysis. Stroke, 201, 42(11): 3311-5.

38. Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, et al. What is the evidence for physical therapy post-stroke? A systematic review and meta-analysis. PLoS One, 2014, 9(2): e87987.

39. De Weerdt W, Feys H. Assessment of physiotherapy for patients with stroke. Lancet, 2002, 359(9302): 182-3.

40. The European Stroke Organisation (ESO) Executive Committee and the ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. www.karger.com/Article/ FullText/131083 (accessed 27 November 2016).

41. National Institute for Health and Care Excellence. Stroke rehabilitation in adults. www.nice.org.uk/guidance/cg162 (accessed 27 November 2016).

42. Scottish Intercollegiate Guidelines Network. SIGN Guideline 118. Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning. www.sign.ac.uk/pdf/sign118.pdf (accessed 1 September 2013).

43. Welmer AK, Holmqvist LW, Sommerfeld DK. Limited fine hand use after stroke and its association with other disabilities. J Rehabil Med, 2008, 40(8): 603-8.

44. Carey LM, Matyas TA. Frequency of discriminative sensory loss in the hand after stroke in a rehabilitation setting. J Rehabil Med, 2011,43(3): 257-63.

45. Ekstrand E, Rylander L, Lexell J., Brogårdh C. Perceived ability to perform daily hand activities after stroke and associated factors: a cross-sectional study. BMC Neurol, 2016, 16(1): 208-217.

46. Remple MS, Bruneau RM, VandenBerg PM, Goertzen C, Kleim JA. Sensitivity of cortical movement representations to motor experience: evidence that skill learning but not strength training induces cortical reorganization. Behav Brain Res, 2001, 123(2): 133-41.

47. Lang CE, Macdonald JR, Reisman DS, Boyd L, Jacobson Kimberley T. et al. Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil, 2009, 90(10): 1692-8.

48. Lang CE, DeJong SL, Beebe JA. Recovery of thumb and finger extension and its relation to grasp performance after stroke. J Neurophysiol, 2009, 102(1): 451-9.

49. Schweighofer N, Han CE, Wolf SL, Arbib MA, Winstein CJ. A functional threshold for longterm use of hand and arm function can be determined: predictions from a computational model and supporting data from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) Trial. Phys Ther, 2009, 9(12): 1327-36.

50. Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R. et al. Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Investigative Team. Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Rando mized Clinical Trial. JAMA, 2016, 315(6): 571-81.

51. Lin KC, Chen YA, Chen CL, Wu CY, Change YF. The effects of bilateral arm training on motor control and functional performance in chronic stroke: a randomized controlled study. Neurorehabil Neural Repair, 2010, 24: 42-51.

52. Kwakkel G, Kolten BJ, Krebs HI. Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabil. Neural Repair, 2008, 22: 111-21.

53. Mehrholz J, Plats T, Kugler J, Pohl M. Electromechanical and robot-assisted arm training for improving arm function and activities of daily living after stroke. Cochrane Database Syst Rev, 2008, 4: CD006876.

54. Luft AR, Hafer-Macko C, Schallert T. Physiological basis of rehabilitation therapeutics in stroke. Stroke recovery and rehabilitation. Edited by Stein J, Harvey RL, Macko RF, Winstein CJ, Zorowitz RD. New York, USA: Demos Medical Publishing, 2009: 145-152.

55. Crisostomo EA, Duncan PW, Propst M et al. Evidence that amphetamine with physical therapy promotes recovery of motor function in stroke patients. Ann Neurol, 1988, 23(1): 94-97.

56. Gladstone DJ, Danells CJ, Armesto A, McIlroy WE, Staines WR, Graham SJ et al. Physiotherapy coupled with dextroamphetamine for rehabilitation after hemiparetic stroke: A randomized, double-blind, placebo-controlled trial. Stroke, 2006, 37(1): 179-185.

57. Breitenstein C, Floel A, Korsukewitz C, Wailke S, Bushuven S, Knecht S. A shift of paradigm: from noradrenergic to dopaminergic modulation of learning? J Neurol Sci, 2006, 248(1–2): 42-47.

58. Plewnia C, Bartels M, Cohen L, Gerloff C. Noradrenergic modulation of human cortex excitability by the presynaptic alpha(2)-antagonist yohimbine. Neurosci Lett, 2001, 307(1): 41-44.

59. Plewnia C, Hoppe J, Cohen LG, Gerloff C. Improved motor skill acquisition after selective stimulation of central norepinephrine. Neurology, 2004, 62(11): 2124-2126.

60. Chollet F, Tardy J, Albucher JF, Thalamas C, Berard E, Lamy C et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol, 2011, 10(2): 123-30.

61. https: //medi.ru/instrukciya/vazobral_1821/.

62. Cahn R, Borzeix MG, Legeai J. The effects of dihydroergocryptine on the neurological and enzyme disorders induced by cerebral ischemia in rats. Resuscitation, 1989, 18(1): 37-48.

63. Батышева Т.Т., Костенко Е.В., Ганжула П.А., Журавлева Е.Ю., Лисинкер Л.Н., Хозова А.А. и др. Комплексная программа вторичной профилактики инсульта: место комбинированного препарата Вазобрал. Consilium medicum, 2007, 2(2): 93-96.

64. Гудкова В.В., Стаховская Л.В., Кирильченко Т.Д., Ковражкина Е.А., Чекнева Н.С., Квасова О.В. и др. Ранняя реабилитация после перенесенного инсульта. Consilium medicum, 2007, 8(8): 692-696.

65. Левин О.С., Баранцевич Е.Р., Бельская Г.Н., Васенина Е.Е., Копишинская С.В., Лукашевич И.Г. и др. Эффективность комбинированного препарата вазобрал при дисциркуляторной энцефалопатии. Журнал неврологии и психиатрии им. С.С. Корсакова, 2014, 10: 25-29.


Для цитирования:


Пизова Н.В. Вопросы реабилитации пациентов после инсульта в амбулаторных условиях. Медицинский Совет. 2018;(12):18-22. https://doi.org/10.21518/2079-701X-2018-12-18-22

For citation:


Pizova N.V. Issues in rehabilitation of patients after stroke in the out-patient setting. Medical Council. 2018;(12):18-22. (In Russ.) https://doi.org/10.21518/2079-701X-2018-12-18-22

Просмотров: 204


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 2079-701X (Print)
ISSN 2658-5790 (Online)