[The GSC I-CAN home rehabilitation program in combination with botulinotherapy in motor rehabilitation of patients with spastic paresis]. / Programma domashnei reabilitatsii GSC 'I-CAN' v sochetanii s botulinoterapiei v dvigatel'noi reabilitatsii patsientov so spasticheskim parezom.

Provision of a continuous, comprehensive and intensive program of motor rehabilitation to patients with spastic paresis remains a significant problem in the organization of outpatient rehabilitation. The GSC 'I-CAN' program is aimed at three main pathological components of spastic paresis: paresis, spasticity and muscle contracture. Moreover, detailed guides and a mobile application with video instructions allow the patient to perform the exercises on their own at home. The article describes the elements of the home rehabilitation program GSC 'I-CAN' and their rationale, represents an overview of clinical studies and describes our experience of working with the program.

[Post-stroke rehabilitation training with a brain-computer interface: a clinical and neuropsychological study]. / Interfeis mozg-komp'iuter v postinsul'tnoi reabilitatsii: kliniko-neiropsikhologicheskoe issledovanie.

AIM: To evaluate the clinical efficacy of BCI-supported mental practice and to reveal specific cognitive impairment which determine mental practice ineffectiveness and inability to perform MI. MATERIAL AND METHODS: Fifty-five hemiplegic patients after first-time stroke (median age 54. 0 [44.0; 61.0], time from onset 6.0 [3.0; 13.0] month) were randomized into two groups - BCI and sham-controlled. Severity of arm paresis was measured by Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA) and Action Research Arm Test (ARAT). Twelve patients from the BCI group were examined using neuropsychological testing. After assessment, patients were trained to imagine kinesthetically a movement under control of BCI with the feedback presented via an exoskeleton. Patients underwent 12 training sessions lasting up to 30 min. In the end of the study, the scores on movement scales, electroencephalographic results obtained during training sessions were analyzed and compared to the results of neuropsychological testing. RESULTS: Evaluation of the UL clinical assessments indicated that both groups improved on ARAT and FMA (sections A-D, H, I) but only the BCI group showed an improvement in the ARAT's grasp score (p=0.012), pinch score (p=0.012), gross movement score (p=0,002). The significant correlation was revealed between particular neuropsychological tests (Taylor Figure test, choice reaction test, Head test) and online accuracy rate. CONCLUSION: These results suggest that adding BCI control to exoskeleton-assisted physical therapy can improve post-stroke rehabilitation outcomes. Neuropsychological testing can be used for screening before mental practice admission and promote personalized rehabilitation.

[The efficacy of botulinum toxin therapy in patients with upper limb spasticity due to traumatic brain injury]. / Effektivnost' botulinoterapii v lechenii spastichnosti verkhnei konechnosti u patsientov s cherepno-mozgovoi travmoi.

Spasticity is a type of muscle hyperactivity that occurs in patients after focal lesions of the Central nervous system due to various diseases: stroke, traumatic brain injury or spinal cord injury, neurosurgical intervention, as well as multiple sclerosis and other diseases of the Central nervous system and is the most disability manifestation of the syndrome of upper motor neuron (UMNS). Focal spasticity of the upper limb requires a complex treatment. Botulinum toxin therapy is an effective treatment for focal/multifocal spasticity in reducing muscle tone and improving function with the highest level of evidence according to the latest American and European guidelines for treatment of spasticity. There are many publications devoted to BTA use in post-stroke patients. This article provides a review of the BTA use in patients with the upper limb spasticity due to severe traumatic brain injury. Some local data on the BTA efficacy in the cohort of patients with traumatic brain injury are also presented.

[Arm Motor Function Recovery during Rehabilitation with the Use of Hand Exoskeleton Controlled by Brain-Computer Interface: a Patient with Severe Brain Damage].

We studied the dynamics of motor function recovery in a patient with severe brain damage in the course of neurorehabilitation using hand exoskeleton controlled by brain-computer interface. For estimating the motor function of paretic arm, we used the biomechanical analysis of movements registered during the course of rehabilitation. After 15 weekly sessions of hand exoskeleton control, the following results were obtained: a) the velocity profile of goal-directed movements of paretic hand became bell-shaped, b) the patient began to extend and abduct the hand which was flexed and adducted in the beginning of rehabilitation, and c) the patient began to supinate the forearm which was pronated in the beginning of rehabilitation. The first result is an evidence of the general improvement of the quality of motor control, while the second and third results prove that the spasticity of paretic arm has decreased.

[Brain-Computer Interface: the First Clinical Experience in Russia].

Motor imagery is suggested to stimulate the same plastic mechanisms in the brain as a real movement. The brain-computer interface (BCI) controls motor imagery by converting EEG during this process into the commands for an external device. This article presents the results of two-stage study of the clinical use of non-invasive BCI in the rehabilitation of patients with severe hemiparesis caused by focal brain damage. It was found that the ability to control BCI did not depend on the duration of a disease, brain lesion localization and the degree of neurological deficit. The first step of the study involved 36 patients; it showed that the efficacy of rehabilitation was higher in the group with the use of BCI (the score on the Action Research Arm Test (ARAT) improved from 1 [0; 2] to 5 [0; 16] points, p = 0.012; no significant improvement was observed in control group). The second step of the study involved 19 patients; the complex BCI-exoskeleton (i.e. with the kinesthetic feedback) was used for motor imagery trainings. The improvement of the motor function of hands was proved by ARAT (the score improved from 2 [0; 37] to 4 [1; 45:5] points, p = 0.005) and Fugl-Meyer scale (from 72 [63; 110 ] to 79 [68; 115] points, p = 0.005).

[Localization of brain electrical activity sources and hemodynamic activity foci during motor imagery].

Studied are sources of brain activity contributing to EEG patterns which correspond to motor imagery. The accuracy of their classification determines the efficiency of brain-computer interface (BCI) allowing for controlling external technical devices directly by brain signals without involving muscle activity. Sources of brain activity are identified by Independent Component Analysis. Those independent components for which the BCI classification accuracy are at maximum are treated as relevant for motor imagery task. Two of the most relevant sources demonstrate strictly exposed event related desynchronization and synchronization of mu--rhythm during imagery of contra--and ipsilateral hands. These sources are localized by solving inverse EEG problem taking into account individual geometry of brain and its covers provided by anatomical MRI images. The sources are shown to be localized in BA 3A relating to proprioceptive sensitivity of the contralateral hand. Their positions are closed to foci of BOLD activity obtained by fMRI.

[Motor imagery and its practical application].

The mechanisms underlying the process of motor imagery are similar to the motor control mechanisms. It can be used for motor learning in patients with movement disorders. Motor imagery may be the only one method for recovery of motor function in patients with severe paresis. It was the prerequisite of increased scientist interest in motor imagery during last decade. Brain-computer interface technology can support the motor imagery trainings.

[Principles of neurorehabilitation based on brain-computer interface and biologically plausible control of the exoskeleton].

The paper examines neurophysiological basis for development and performance of brain-computer interface (BCI) that permits cerebral activity alone to control computers or other external technical devices. BCI based on the discrimination of EEG patterns related to an imagery of extremity movements is considered. The problem of BCI application to restoring of motor functions in patients with motor disabilities is discussed.