Original article

Neuroprosthetic Technology «Bioness» (Exorobot) in the Process of Restoring Motor and Vegetative-Trophic Disorders in Central Paresis of the Upper Limb

1 ORCIDVozniuk I.A., 1 ORCIDPolyakova A.V., 1 ORCIDTokareva D.V.

1 Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, Saint-Petersburg, Russian Federation


Abstract:

Disability after the stroke or brain injury is most often associated with impaired movement, speech, swallowing, and reduced cognitive abilities. By the end of the acute period of stroke, paresis in an arm and a leg of varying degrees is observed in 80-90 % of survivors. In case of severe paresis, it is advisable to support the function of the limb at the early recovery stages using modern specialized modifiable devices and methods that provide functional and multimodal stimulation and partial prosthetics.

Aim. Evaluation of the functional electrical stimulation (FES) efficacy in a complex of multimodal effects in restoring movement in stroke patients with upper limb paresis (palcy).

Material and methods. Stimulation and neuroprosthetic methods (FES - “Bioness H200”, RTMS) were used as the main therapeutic program of rehabilitation treatment for patients with motor disorders of the upper limb after an ischemic stroke (n=140). The median period of stroke was 25 [13; 56] days, median age 52 [48; 69] years. In accordance with Order of the Ministry of Health of the Russian Federation No. 928n and 1705n (2012) the standard methods of diagnosis and treatment of patients with stroke were used, as well as scales and questionnaires for assessing the loss of strength and volume of motor disorders, assessing depression and motivation for treatment.

Results. The effectiveness of personalized therapy with the use of the neuroprosthesis (“Bioness H200”) in patients in the acute period of ischemic stroke was shown, with the Motrisight index, Fugle-Meier scale being the most sensitive scales. The results depend on the basic disease characteristics, the most relevant of which were - focus, degree of neurological deficit, personal motivation. In addition, using of botulinum toxin allowed eliminating the inhibitory effect of spasticity that prepared patients for intensive methods of physical rehabilitation. During the follow up period, no complications were revealed. In 90% of cases, an increase in daily activity was noted. Functional electrical stimulation has significantly increased their level of selfcare. The disability complex was initially equally pronounced in all patients, but positive reinforcement in the form of movement of the paretic hand against the background of FES led to a decrease in the severity of depression. In 100%, there was a high motivation to continue the treatment program with neuroprosthetics.

Conclusion. The use of a complex of stimulating personalized techniques in the acute period of stroke is justified and safe. The use of FES significantly increases the range of motion in the hand, helps to overcome power paresis, coordination disorders, increases the general level of physical activity of patients after the stroke, motivation for the recovery process and improves the quality of life.


Keywords: rehabilitation, acute stroke, acute period, multimodal stimulation, functional electrical stimulation, botulinum therapy, movement disorders

For citation: Vozniuk I.A., Polyakova A.V., tokareva D.V. Neuroprosthetic technology «Bioness» (Exorobot) in the Process of Restoring Motor and Vegetative-trophic Disorders in Central Paresis of the Upper Limb. Bulletin of Rehabilitation Medicine. 2020; 5 ( 99): 62–69. https://doi.org/10.38025/2078-1962-2020-99-5-62-69



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