[Rehabilitation of patients with facial nerve neuropathy in cases of increased muscle tone on the healthy side of the face]. / Reabilitatsiya patsientov s neiropatiei litsevogo nerva pri povyshenii tonusa myshts na zdorovoi storone litsa.

OBJECTIVE: To evaluate the effectiveness of physical rehabilitation (PR) and injections of botulinum toxin type A (BTA) in the correction of muscles hypertonicity ty of the healthy side of the face or its prevention in patients with facial nerve neuropathy (FNN). MATERIAL AND METHODS: One hundred and forty-six patients with FNN of various etiologies with muscles hypertonicity of the healthy side or the risk of its development were studied. The term of treatment was 33 [10; 99] days. There are 88 women and 58 men aged 42 [34; 56] years. Diagnosis included clinical examination and stimulation electroneuromyography (ENMG, n=113; 77.4%) with assessment of M-wave amplitude asymmetry. All patients were prescribed a standard PR complex, in addition - relaxation of the muscles of the healthy side by injections of BTA (Incobotulinumtoxin A) - BTA group (n=38) or by special PR techniques - physiotherapy group (n=108). RESULTS: In both groups, patients were comparable in age, sex and severity of FNN at clinical assessment. But objectively, in the BTA group there were more symptomatic forms (63.2% vs 43.5%; p=0.038), cases of M-wave amplitude asymmetry over 90% in ≥2 branches (52.6% vs 18.5%; p=0.032). Displacement of the face midline was a factor limiting recovery (68.4% and 62%; χ2=0.495; p=0.482) in two groups. With amplitude asymmetry of more than 90% in ≥2 branches (a predictor of the risk of unfavorable outcome), a favorable outcome occurred more often in the BTA group (80% versus 45%; χ2=5.227; p=0.023). In case of amplitude asymmetry of less than 90% in all branches, a favorable outcome was observed in two groups. CONCLUSION: Indications for botulinum therapy in patients with FNN are deep prosoparesis or prosoplegia, muscles hypertonicity of the healthy side, displacement of the face midline, ENMG predictors of the risk of unfavorable outcome. PR is an effective method of prevention in patients with a favorable prognosis of outcome or treatment of mild forms.

[Rehabilitation of patients with complications of facial nerve neuropathy]. / Reabilitatsiya patsientov s oslozhneniyami neiropatii litsevogo nerva.

OBJECTIVE: To compare the effectiveness of physical rehabilitation (PR) and botulinum therapy in the treatment of facial nerve neuropathy (FNN) complications. MATERIAL AND METHODS: Sixty-eight patients with FNN of various etiologies, including 70 women and 6 men aged 38 [31; 46] years, were studied. Time to seek medical help was 717 [256; 1638] days. Diagnosis of the motor pattern included determining the strength of facial muscles, identifying complications - muscle hypertonicity and synkinesis, assessment with the House-Brackmann Grading System, the Facial Nerve Grading System 2.0 and the Sunnybrook facial grading system. All patients were prescribed a standard PR complex, additionally muscle relaxation was performed on both sides by injections of Incobotulinumtoxin A (BTA) - BTA group (n=34; 44.7%) or special PR techniques - physiotherapy group (n=42; 55.3%). RESULTS: The both groups are comparable by age, sex, etiology and duration of treatment, however, patients in the BTA group have more severe stage of FNN (U=534.5; p=0.031). There is a limitation in the volume of active movements in patients with muscles hypertonicity of the affected side, which was associated with insufficient muscle strength. In the BTA group, the severity of complications (muscles hypertonicity and synkinesis) is decreased on the affected side, and in 1/4 of the cases it is accompanied by an increase of muscles strength. In the physiotherapy group, the decrease in the severity of complications is less significant, but is associated with an increase of muscles strength (χ2=45.505; p<0001). CONCLUSIONS: PR and botulinum toxin therapy are effective methods of treating FNN complications. Special PR techniques for relaxing and stretching muscles are applicable for the prevention and treatment of mild disorders. Botulinum therapy allows achieving a significant stable clinical effect in the treatment of moderate and severe complications (muscle hypertonicity and synkinesis).

[The neuropathy of marginal mandibular branch of the facial nerve]. / Izolirovannoe porazhenie kraevoi nizhnechelyustnoi vetvi litsevogo nerva.

OBJECTIVE: To analyze the diagnosis, treatment and rehabiltation of patients with marginal mandibular branch of the facial nerve (MMB). MATERIAL AND METHODS: We have collected 6 patients (mean age 40 [33.8; 44] years) with isolated lesion of MMB that innervates the depressor labii inferioris and chin muscle. The illness duration without any improvement was 35 [13; 44] days. Diagnosis and treatment were carried out according to the special algorithm developed and implemented at the N.V. Sklifosovsky Research Institute of Emergency Medicine. RESULTS: With needle myography of the muscle that lowers the lower lip, the change in the ratio of the maximum amplitudes of the interference pattern (MAIP) in all patients exceeded 15%, and in 2 cases it was more than 90%. Comparing with the healthy face side, a change of the MAIP ratio less than 90% was considered as the biomarker of favorable prognosis, with conservative treatment recommendations, e.g. the set of exercises with targeted effects on depressor labii inferioris. With regular exercises, patients noted positive dynamics of restoring the symmetry of the smile in 1-2 months of the disease, full recovery - in 4-5 months. In case of exercises rejection, there was no positive dynamics. A change in the MAIP ratio more than 90% or the absence of motor unit potentials was considered as the biomarker of an unfavorable outcome and an indication for surgical treatment. After surgical treatment, the improvement occurred within 4-5 months. In conservative treatment group, there were no positive changes even with regular exercises. CONCLUSION: The diagnosis of an isolated lesion of MMB is established clinically using a protocol of step-by-step assessment of facial muscle function, and tactics is determined by needle myography with depressor labii inferioris. Even with favorable myographic predictors, spontaneous recovery may not occur, exercises with a targeted effect on the depressor labii inferioris are required, and in the presence of unfavorable predictors, surgical treatment is reccomended.

[New perspectives of motor rehabilitation of patients after focal brain lesions]. / Novye perspektivy dvigatel'noi reabilitatsii patsientov posle ochagovogo porazheniia golovnogo mozga.

Rehabilitation of patients after focal brain lesions is one of the topical issues of modern medicine. Motor disorders are known to develop in more than 80% of survivors of stroke and traumatic brain injury and be one of the main causes of disability, which necessitates an active search for new effective techniques for correction of motor disorders. Modern rehabilitation includes both traditional techniques for recovery of patients with motor deficit (exercise therapy and physiotherapy) and botulinum therapy, kinesiotherapy, mechanotherapy, etc., which have been developed in recent years. Robotic technologies have been developed, improved, and implemented. Currently, due to progress in computerization, virtual reality-based rehabilitation of patients is of particular interest. The article reviews the key studies in this field. We describe various visualization methods and means of immersion in a virtual environment for recovery of upper and lower extremity function in patients with focal brain lesions. The study provides an assessment of the effectiveness and safety of various virtual reality-based rehabilitation programs in patients with motor disorders after stroke and traumatic brain injury.