[Clinical and functional outcomes of valgus osteotomy in patients with medial gonarthrosis (preliminary results)]. / Rezul'taty val'giziruyushchei osteotomii u patsientov s medial'nym gonartrozom (predvaritel'nye rezul'taty).

OBJECTIVE: To analyze gait biomechanics before and after corrective osteotomies around the knee joint in patients with medial gonarthrosis. MATERIAL AND METHODS: The study recruited 5 patients (6 surgeries) with medial gonartrosis and varus knee deformity. Gait biomechanics was analyzed in preoperative period and 6 months later. The control group consisted of 20 healthy people. RESULTS: Knee joint biomechanics was almost normal in postoperative period. Amplitude of knee joint flexion was increased. Moreover, hip joint flexion-extension amplitude was increased on both sides and often exceeded normal values. Clinical results showed significant increase in IKS (from 55 to 89.6) and VAS score (from 7.7 to 2.3). Postoperative correction angle varied within 1.5-2° of valgus. CONCLUSION: Corrective osteotomy around the knee joint is effective for medial gonarthrosis. We obtained favorable clinical results and limb axis correction after surgery without significant hypercorrection. Gait biomechanics was also improved.

[The restoration of the shoulder joint function in the patients presenting with hemiparesis during the acute phase of hemispheric stroke]. / Vosstanovlenie funktsii plechevogo sustava u patsientov s gemiparezom v ostryi period polusharnogo insul'ta.

The impaired function of the shoulder joint resulting from cerebral stroke is a common disorder involving permanent total disability as well as impaired capability of self-care. The functional pathological changes in the shoulder joint and the dynamics of the patients' health status during the acute period of cerebral stroke remain virtually unexplored. AIM: The objective of the present study was to obtain a deeper insight into the process of recovery of the movements in the shoulder joint of the patients presenting with hemiparesis during the acute period of hemispheric stroke based on the results of the analysis of the biomechanical data and the targeted training with biofeedback (BFB). MATERIAL AND METHODS: The study included three groups comprised of 25 subjects each. One (control) group included the subjects having neither neurological nor orthopedic pathology. The second group consisted of the patients receiving the conventional treatment in the combination with therapeutic physical exercises (TPE). Group 3 was composed of the patients given the standard course of conventional and physical (TPE) therapy complemented by biofeedback training (the TPE/BFB group). The study included clinical investigations and biomechanical registration of the movements of the shoulder joints and trunk. RESULTS: The results of the study gave evidence that the patients presenting with hemiparesis during the acute period of hemispheric ischemic stroke including those treated with the application of the active means and methods of rehabilitation, such as BFB training, showed no appreciable dynamics of the parameters being evaluated with the use of the relevant clinical scales. The biomechanical study has demonstrated that the movements in the shoulder joints (in a single plain) of the patients comprising the control group are characterized by the presence of the main component with a maximum amplitude in the plane of this movement and additional components (in other planes with a significantly lower amplitude); they are accompanied by the ancillary movements of the trunk. Functionally, the condition of paresis at the level of the shoulder joint is characterized by a decrease in the amplitude of the primary movement and the increase of one of the additional amplitudes, with the growing amplitude of the auxiliary movements of the trunk. The biomechanical methods for the objective assessment have revealed the following functional changes in the shoulder joints: the 6% improvement of flexion in the group of the patients treated with the use of therapeutic physical exercises and the 10% improvement in those treated with the combination of TPE and BFB. Moreover, abduction in the patients of these two groups improved by 4% and 9% respectively. CONCLUSIONS: The method for the study of kinematics of the movements in the shoulder joints appears to be most sensitive and informative for the purpose of diagnostics of disorders of the motor function and assessment of the process of its restoration in the patients presenting with hemiparesis during the acute period of hemispheric stroke.

[The dynamics of shoulder joint function in patients with hemiparesis in the acute period of carotid stroke]. / Dinamika funktsii myshts plechevogo poiasa u bol'nykh s gemiparezom v ostrom periode karotidnogo insul'ta.

AIM: To evaluate the recovery of shoulder joint function in patients with hemiparesis in the acute period of hemispheric stroke on the basis of the analysis of electromyography (fEMG) of the muscles of this region before and after rehabilitation measures, including targeted training with biofeedback (BFB). MATERIAL AND METHODS: Three groups of 25 people each were studied. Patients of the physical therapy (PT) group received standard treatment and physical therapy; patients of the PT+BFB group received BFB training in addition to PT; the control group consisted of people without neurological and orthopedic symptoms. A clinical study and EMG of the muscles of the shoulder girdle during testing movements was performed. RESULTS: On the side of paresis, the function of muscles was characterized by a decrease in the bioelectric activity (movement amplitude was decreased as well) and later phase of the maximum EMG activity compared to the norm. The time of maximum EMG activity had a trend towards the shift to the normal values during the treatment process, but the difference reached a statistically significant level not for all muscles and all movements. There were variants of the functions of the paretic muscles accompanied by the increased EMG activity. In the early stages (up to 21 days) of stroke, no significant changes in the EMG activity of shoulder girdle muscles were observed. The PT+BFB group showed better results than the PT group not only in the onset of activity, but also in the reduction of the amplitude when performing the same movement that indirectly suggested the more optimal inclusion of muscles in the motor act. In the period of acute hemispheric stroke, there were changes not only in the EMG activity of muscles of the affected side, but also of the contralateral side. CONCLUSION: A fEMG of the muscles is a more sensitive and informative method of the diagnosis of disorders of motor function and assessment of recovery process of the muscles of the shoulder joint in patients with hemiparesis.

[A complex study of the movement biomechanics in patients with post-stroke hemiparesis].

The authors present results of a pilot study on biomechanics of non-cyclic movements of the human consequent verticalization in the ontogenesis of patients with post-stroke hemiparesis (10 patients in the acute stage of cerebral stroke) and 10 healthy volunteers without neurologic and orthopedic pathology. Some movements of therapeutic exercises Balance (a model of ontogenetic kinesitherapy) have been selected for the study. Cinematic parameters have been recorded using a system of motion 3D video analysis, a kinematic model was build in accordance to standard protocols. The skin (native and straightened) electromyogram (EMG) was recorded synchronously with kinematic data using 16-channel electromyography from the following pairs of muscles: mm. sternocleido-mastoideus, trapezius (горизонтальная порция), biceps brachii, triceps brachii, rectus femoris, adductor magnus. Major differences in the EMG picture between patients and controls were: 1) the EMG "monotony" with the involvement of multiple additional muscles in locomotions with the prevalence of the peculiar "tonic" muscle activity (low amplitudes without distinct peaks), stretching along the whole cycle of movement. In controls, EMG demonstrated variability and had mostly "phasic" character with distinct 1 or 2 peaks; 2) the asymmetry of EMG profile in symmetric movements. i.e. when performed simultaneously from the right and from the left sides. The latter feature may be considered as predictive because it was never found in healthy people. It allows to identify objectively weak muscles even in the absence of visible parethis during the routine neurological examination.

[Posturographic rapid diagnosis of a vestibular function in vestibulology].

The integral index of equilibrium function (IIEF) was proposed for rapid diagnosis of the equilibrium function. Calculation of IIEF is based on comparison of the results of resting stabilometry in European position of the patient's feet with those of functional tests (optostimulation, sight deprivation, Romberg's position with sight deprivation). Calculations of stability and dynamic component indices were made using the parameter of the deviation rate of the pressure center of a human body standing on the stabilometer platform. IIEF was estimated in 118 healthy subjects aged from 17 to 82 years. Age- and sex-related differences in some age groups were studied.

[Functional characteristics of gait and standing posture in poststroke patients in residual period]. / Funktsional'nye pokazateli pokhodki i osnovnoi stoiki u postinsul'tnykh bol'nykh v rezidual'nom periode.

Using biomechanic method, gait and standing posture were studied in 17 stroke patients in a remote poststroke period. The locomotor system was found to have non-specific compensatory changes to optimize motor functions and reduce functional disturbances. Symptoms of the triceps surae muscle insufficiency as well as a balance deficit at standing posture and displacement of the center of pressure towards the non-affected side were characteristic of the given stage of rehabilitation stroke period that should be taken into account during the rehabilitation treatment.