STRATEGY FOR USE OF NON-MEDICINAL METHODS OF REHABILITATION OF PATIENTS IN THE RECOVERY PERIOD OF HEMORRHAGIC STROKE

Abstract

Summary. The problem of recovery of patients after a hemorrhagic stroke is one of the urgent issues of modern rehabilitation. According to statistical data, 48 % of stroke patients experience disabling hemiparesis, 30 % develop psycho-organic syndromes, and only 10–15 % of patients return to work. This indicates the relevance of this problem and the need to find ways to improve and optimize the recovery process in this group of patients. One of the factors of cerebral blood circulation disorders is the imbalance of nucleic homeostasis, it correlates with the severity of the disease, which allows us to assess the dynamics of focal and general brain symptoms.

The aim – to study the effectiveness of non-medicinal means of treatment in the rehabilitation of patients with the consequences of impaired cerebral blood circulation in the recovery period (3–10 months after a hemorrhage). To compare the obtained results with the data obtained after classical rehabilitation in patients from the control group.

Material and Methods. The work investigated the effectiveness of rehabilitation measures using non-medicinal treatment methods: hirudotherapy, apitherapy, reflexotherapy and manual therapy in 66 patients with the consequences of a hemorrhagic stroke in the late recovery period. To objectify the research data, rating scales were used at the beginning of treatment, then – one and three months after it. Neurological status was evaluated according to the National Institutes of Health Stroke Scale (NIHSS), the degree of muscle tone increase according to the modified Ashforth spasticity scale. The dynamics of the functional state of the patients was evaluated according to the Rankin scale, the Barthel index of daily life activity, cognitive functions – according to the Mini-Mental State Examination (MMSE) scale, and the psycho-emotional state was evaluated according to the Beck and Montgomery-Asberg scales. The work determined the level of nucleic acids (DNA, RNA) and the activity of acidic and alkaline nucleases in blood serum at the beginning and at the end of treatment. These results were compared with the results of rehabilitation in patients from the control group (n=50) who received the classic scheme of rehabilitation.

Results. A probable improvement in the condition of the patient with the consequences of a hemorrhagic stroke was established, which was manifested in the recovery of functioning indicators on the Rankin scale by 14 % after the first and 29 % after the third month of treatment, p<0.05. The improvement according to the Barthel index was 9 % after the first and 20 % after the third month, respectively, p<0.05. Reduction of muscle spasticity according to the Ashworth scale was 12 %, cognitive functions recovered by 19 % after treatment compared to the state at the beginning of treatment. The psycho-emotional state improved by 44 % and 40 %, p<0.05 (according to the MADRS scale and the Beck scale) after the rehabilitation compared to the state at the beginning of the treatment, respectively. The psycho-emotional state improved by 44 % and 40 %, p<0.05 (according to the MADRS scale and the Beck scale) after the rehabilitation compared to the state at the beginning of the treatment, respectively. After the rehabilitation, a decrease in the level of DNA and an increase in the amount of RNA in the patients' blood serum were observed. Changes in the activity of nucleases and the corresponding coefficients of their relationships (decrease in the level of DNase I and RNase II, increase in RNase I and DNase II, increase in the coefficients of K1 and K3, decrease in the level of K2). Improvement of these indicators in the main group of patients was significantly better than in the comparison group.

Conclusions. Prescribing a rehabilitation program with the use of non-medicinal means of treatment in patients with the consequences of a hemorrhagic stroke in the late recovery period improves the functional indicators of the general condition of the patients, reduces the spasticity of the affected muscles and disability, increases the activity indicators and the psycho-emotional state of the patients. Changes in nucleic homeostasis indicate a decrease in the processes of decay and autolysis of brain cells and the activation of regenerative processes in comparison with the control group.