[The modern approaches to the restoration of postural balance in the patients suffering from the consequences of an acute cerebrovascular accident (CVA)].

BACKGROUND: the most frequent and severe consequences of an acute cerebrovascular accident (CVA) are locomotor and coordination disorders which significantly increase the risk of falling in a static position and when walking. The methods used for the rehabilitation of the affected patients are designed in the first place to enable the patients to acquire the skills necessary for maintaining the static balance. The modern equipment allows to carry out coordination training in the static position and also during walking. AIM: The objective of the present study was to evaluate, based on the results of our original research, the feasibility and effectiveness of the application of the «Balance tutor¼ system developed for the restoration of static and dynamic balance in the framework of the combined rehabilitation treatment of the patients suffering from impaired postural balance as a consequence of acute cerebrovascular accident (CVA). MATERIALS AND METHODS: A total of 56 patients presenting with impaired postural balance following CVA were available for the examination. All of them underwent functional testing to assess the static and dynamic balance, walking abilities, and the risk of falling down including the study with the use of computer-assisted stabilometry. RESULTS: The study has demonstrated that the inclusion of the «Balance tutor¼ system for the restoration of the static and dynamic balance in the combined rehabilitative treatment of the patients having postural balance disorders after the CVA reduces the risk of fall for a walking patient, improves his (her) static and dynamic balance, increases the patient's ability to move without exterior help. The patients comprising the main study group were found to experience a decrease of statokinesiogram space in the «eyes are open¼ position (p = 0.0576, the Mann-Whitney U test) as well as a reliable decrease of the statokinesiogram space in the «eyes are closed¼ position (p=0.0063, the Mann-Whitney U test). Similar changes occurred in speed of pressure center relocation. By the end of the rehabilitation course, the patients of the main group exhibited a reliable enhancement in the dynamic balance rates estimated with the use of the Berg Balance Scale (p=0.028, Tukey's criterion), an increase in stability based at the Tinneti scale, p=0.0291; Tukey's criterion), and a decrease of the risk of falling during walk assessed with the application of Dynamic Gait Index scale (p = 0.0001, Tukey's criterion). DISCUSSION: The results of the present study with the inclusion of the «Balance tutor¼ system in the program of combined rehabilitation of the patients suffering from the consequences of CVA in the form of the postural balance impairment give evidence of the feasibility and effectiveness of this approach. There is reason to believe that its application is likely to reduce the risk of falling down and to improve characteristics of static and dynamic balance. CONCLUSION: The inclusion of the «Balance tutor¼ system in the program of combined rehabilitation of the patients suffering from the consequences of CVA in the form of the postural balance impairment is both feasible and effective.

[The application of the acupuncture techniques for the combined treatment of neurotic tics in the children]. / Ispol'zovanie metodov refleksoterapii v kompleksnom lechenii nevroticheskikh tikov u detei.

At present, the frequency of neurosis in the children is growing under the influence of the increasingly intensive stressful factors. The neurotic ticks are one of the manifestations of neurosis in the children characterized by involuntary movements; they are often accompanied by hyperactivity, deficit of attention, fatigue, and headaches. AIM: The objective of the present study was to evaluate the effectiveness of acupuncture used for the treatment of neurotic tics in the children. MATERIAL AND METHODS: The study was carried out at the basis of the department of children's rehabilitation of the Moscow city polyclinic #39. All the children were counselled by a neurologist, psychologist, and acupuncturist. An electroencephalogram was obtained from each patient and a questionnaire study involving the patients' parents was conducted. The patients were treated with the application of reflexotherapy and were given recommendations of a psychologist. A total of 30 children at the age from 6 to 12 years were available for the examination. The participants of the study were allocated to two groups depending on the strategy of the outpatient care. Group 1 was comprised of the patients (n=17) who were given 3 courses of reflexotherapy in addition to pharmacotherapy and psychologist's recommendations. The patients included in group 2 served as controls (n=13) and received only medications and psychotherapy without acupuncture. The effectiveness of the treatment was evaluated based on the dynamics of the patients' complaints. RESULTS AND DISCUSSION: The resullts of the study give evidence of the higher effectiveness of the treatment of the children suffering from neurotic ticks with the application of acupuncture therapy compared with the conventional approach. A few courses of reflexotherapy provided in the combination with pharmacotherapy and the compliance with the recommendations of a psychologist resulted in the more efficient elimination of the neurotic tics together with the associated hyperactivity, deficit of attention, fatigue, and headaches than the use of medication therapy and psychotherapy without acupuncture.