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COMPLEX KINESITHERAPEUTIC APPROACH AFTER SUPRATENTORIAL UNILATERAL STROKE IN THE CHRONIC PERIOD Ass.prof. Danche Vasileva, PhD Full Prof. Daniela Lubenova, PhD 

Medical Medical and social and social significance significance of str of stroke oke Morbidity a Morbidity and nd disa disabili bility ty

Mechanisms for functional recovery Acute phase Chronic phase ➢ processes take place on: ➢ there is a complex restitution (biological recovery of the bilateral reorganization brain lesion), adaptive reorganization involving the more intact (engagement of new synapses and neural side (respectively the networks) and / or compensatory intact hemisphere). strategies (replacement behavior through re-training other than the normal response)

Effect of kinesitherapy Acute phase Chronic phase ➢ ➢ Stimulates compensatory behavioral Stimulates and promotes strategies related to behavioral spontaneous repair of reorganization. ➢ It is used to train the non-damaged brain motor disorders. cells in the execution of certain functions.

The aim The aim The he aim of aim of th the e st stud udy y is is to to e eva valua luate te th the e ef effec ect of t of t the he co comple mplex x kine kinesith sither erape peut utic ic app pproa oach h an and d th the sp e spec eciali ialized ed kine kinesith sither erape peut utic ic met metho hod d (SKTM) (SKTM) in in pa patien tients ts with with su supr prate tent ntor orial ial un unil ilate teral al st strok oke e in in th the e chr hron onic ic pe period riod (SUSC SUSChP hP). ).

Tasks Tasks 1. 1. To o de develop elop a sp a spec eciali ialized ed me meth thod odolo ology y for or kin kines esith ither erapy ba base sed d on on th the e mod moder ern n pr principles inciples of of ne neur uror oreh ehabili bilita tation tion an and d ad adapt pted ed for or home home us use e in pa in patien tients ts with with un unila ilate teral al chr hron onic ic st strok oke. e.

Tasks Tasks 2. 2. To o st stud udy y th the e ea early y (10t (10th h da day) y) an and d la late te (1st (1st mon month th) ) ef effec ect of t of the the app ppli lica cation tion of of sp spec ecializ ialized ed kin kines esith ither erapy y in in pa patie tient nts s with with chr hron onic ic he hemipar mipares esis, is, in in co compa mpariso rison n with with th the e co cont ntrol ol grou oup, , whic hich h is is th the us e usua ual l kin kines esith ither erapy, , on on: (a) (a) motor motor reco ecover ery y fun functionalit ctionalities; ies; (b) (b) equilibrium equilibrium oppor opportunit tunities; ies; (c (c) ) gait gait kine kinetic par tic parame ameter ters; s; d) or d) orthos thosta tatic tic reactiv eactivity ity.

Tasks 3. 3. To o look look for or signifi significa cant nt co correla elation tions s be betw twee een n so some me pe perma mane nent nt risk risk fac acto tors s (gen (gende der, , age ge) ) an and d st strok oke e cha harac acte terist ristics ics (l (limi imita tation tion, , loca locali liza zation tion an and d se sever erity) ity) on on th the e ef effec ect o t of kin kines esith ither erapy.

Methods Methods of study of study 1. 1. Sp Spec ecializ ialized ed kin kines esith ither erap apeu eutic tic met metho hodo dology logy (wi (with th 1 mont 1 month h du dura ration tion); ); 2. 2. Usu Usual al kine kinesith sither erap apeu eutic tic met metho hodo dology logy (wi (with th a 10 a 10 da day y du dura ration tion)

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology The he pu purpo pose se of of SKTM SKTM Im Impr proving ving the functiona the functional l ca capacity pacity of of pa patients tients with i with isc schemic hemic str strok oke e in in the the chr hronic period onic period.

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology Tasks asks 1. 1. Impr Improvem emen ent t of of mus muscle le st stren engt gth, h, sp spas asticity ticity an and d favor orable ble infl influe uenc nce e on on the th e mot motor or ca capa pabili bilities ties of of the the pa patien tient. t. 2. 2. Nor Normaliz malization tion of of p pos ostu tural al co cont ntrol ol in in sitt sitting ing an and d st stan anding ding.

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology 3. 3. Positiv ositive e infl influe uenc nce e on on w walking alking disor disorde ders s an and d fun function ctional al inde indepe pend nden ence ce of of th the pa e patient. tient. 4. 4. Impr Improveme ement nt of of o ortho thosta static r tic rea eactivit ctivity y in in pa patients tients wi with th or ortho thosta static into tic intoler leran ance ce. 5. 5. Ov Over erall c all calming alming of of the the bo body dy afte after e r exer ercise cise. . Sp Spee eeding ding up up the r the rec ecover ery pr y proc ocess esses es an and d ha having ving a pos a positi itive e ef effec ect on t on the the ner nervou ous s syste system. m.

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology Methodological characteristics for practical application of the included movements Training aining in in rot otating ting fr from om Moving Mo ving fr from om lying ying po positi sition on occipita oc cipital lay l lay to to side side lying ying po positi sition on to sea to seat

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology Mo Moving ving fr from om sea seate ted d to to stan standing ding Mo Moving ving fr from om be bed d to to cha hair ir

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology Moveme Mo ement nts i s in n closed losed kinet kinetic ic Stimula Sti mulating ting a r a rea eact ction of ion of a a cha hain and in and fac acil ilita itating ting support su

Specialized Specialized kinesitherapeutic kinesitherapeutic methodology methodology Moveme Movement nts i s in n a semi a semi close closed d Movement Moveme nts i s in n op open en kine kinetic tic kine kinetic tic ch chain ain an and fac d facil ilitating itating ch chain for ain for up uppe per r li limb mb

Specialized kinesitherapeutic methodology Training aining in in inde indepe pend nden ent t stanc sta nce Moving Moving from from sea seate ted d to to stand sta nding ing Seat wi Seat with th an and d wi with thou out t th the sup e suppo port rt of of th the lower e lower li limbs mbs

Specialized kinesitherapeutic methodology Training Training in in sta stand nding ing po positi sition on wi with th weight weight Walking Walking tra training ining tra transfe nsfer

Comparative characteristics between SCTM and control methodology The applied two kinesitherapy techniques are different in their duration of treatment, structure and included kinesitherapeutic agents (postural movements, walking, active upper limb movements and transfers). SCTM adheres to the principles of modern neurorehabilitation and motor training, as opposed to conventional kinesitherapy.

Methods Methods for evaluating the for evaluating the tr treatment performed eatment performed ➢ Che Chedo doke-McMast McMaster er te test st to to as asse sess ss th the e se sever erity ity of of mo moveme ement nt res estr triction ictions s in in (po (point ints) s) ➢ Ash Ashwor orth th Sca Scale le for or Musc Muscle le Ton one e Ass Asses essme sment nt (point (points) s) ➢ Fu Func nctio tiona nal l ind indep epen ende denc nce e me meas asur ure e (point (points) s) ➢ Ber Berg g ba balanc lance e sc scale ale (point (points) s) ➢ Ga Gait it St Stud udy y - Ca Cada danc nce (nu (numb mber er of of ste steps ps) ) an and d sp spee eed d (m (m / min) / min) ➢ Act Activ ive e or orth thos osta tatic tic te test st

Methods Methods Sta Statist tistical ical meth method ods 1. 1. Vari Variation ation (S (Stud tuden ent-Fish Fisher t er t-test), test), 2. 2. Al Alterna ternative tive 3. 3. Correla Correlation tion an analys alysis is 4. 4. Wil Wilco coxo xon n test test 5. 5. Th The e Man Mann-Whit Whitney U ney U-test test 6. 6. Pa Paired ired Sa Samples mples Te Test st 7. 7. Sp Spea earman rman co correlati rrelation on a ana nalysis lysis

Study contingent Study contingent

Con Continge tingent nt Includ Including ing cr criter iteria: ia: ➢ Su Supra praten tentorial un torial unil ilate ateral strok ral stroke ➢ Have Have m mil ild d or mode or moderate residu rate residual, al, ch chron ronic ic he hemi mipa paresis resis ➢ Medica Medication thera tion therapy sh py shou ould ld no not b t be e altered altered during during motor motor the therap rapy