EFFECTS OF KINESITHERAPY ON PHYSICAL PERFORMANCE IN PATIENTS WITH CHRONIC STROKE

Abstract

Stroke is a common disease that can cause motor dysfunction (Song, 2018). Monitoring the recovery process in stroke patients in the chronic period is performed through a set of tests, assessment of structural and functional disorders. The Fugl-Meyer rating scale is an index for assessing sensorimotor impairment in individuals who have had stroke. First proposed by Axel Fugl-Meyer and his colleagues in 1975, as a standardized test for assessing recovery from stroke (Kim, 2021). The Fugl-Meyer scale was developed as the first quantitative assessment tool to measure sensorimotor recovery in stroke, based on Twitchell and Brunnström's concept of successive stages of motor recovery in patients with hemiplegia (Gladstone, 2002). It is used clinically in studies to determine the severity of the disease, to describe motor recovery, and to plan and evaluate treatment (Zeltzer, 2010), and the reliability of the Fugl-Meyer evaluation to test motor performance in patients after stroke is high (Sanford, 1993). According to the International Classification of Functioning, Disability and Health (ICF), the scale assesses body function. Based on the available evidence, the Fugl-Meyer motor scale is strongly recommended as a clinical and research tool for assessing changes in motor impairment after stroke (Gladstone, 2002). The aim of the present study was to investigate the effect on physical performance from the application of a specialized kinesitherapy technique to a routine approach to motor therapy in patients with chronic stroke. The study included 46 patients with chronic stroke, the experimental group included 34 patients - 16 men and 18 women, with a disease duration of 27.15 ± 17.61 months, and the control group, including 12 patients - 5 men and 7 women. , with a disease duration of 19.5 ± 14.68 months. Evaluation of early, intermediate and late effects of the conducted kinesitherapy was performed, respectively on the 10th day, 1st month and 3rd month from the beginning of the program. The study showed a significant improvement in the physical performance of patients in the experimental group in terms of lower limb performance, balance, sensation, proprioception, passive range of motion and pain. In conclusion, the application of motor therapy aimed at improving the functioning of the body in patients with chronic stroke, shows lasting improvements in quality of life, self-movement and self-care. It is recommended that the motor program be modified according to the patient's needs. The individual orientation and the performance of kinesitherapy in outpatient conditions lead to an increase in the patient's motivation and the achievement of the set goals. Additional information: Clinically, stroke recovery is mainly associated with cerebral plasticity in the adjacent cortex (Lyubenova and Tityanova, 2012). The brain tends to recognize visual feedback before proprioceptive or somatic feedback. Mirror therapy is based on the neuroplasticity proposed by this theory (Lim, Lee, Yoo, Yun & Hwang, 2016). This is the reason why this type of therapy is included in the experimental group. It showed definitive motor and sensory improvements, although the degree of improvement in sensory impairment and hemineglect was limited (Gandhi, Sterba, Khatter & Pandian, 2020). The data show that mirror therapy can reduce chronic pain when it is an accompanying part of the therapeutic program (Nikovska, 2019).