CHANGES IN POSTURAL CONTROL IN PATIENTS WITH CHRONIC STROKE
Keywords:kinesitherapy, postural control, stroke, chronic period
Stroke is an acute disorder of cerebral circulation (Lubenova, 2011) and is one of the leading causes of permanent disability and inability of patients to self-care. Postural control includes control of body position in space, for stability and orientation (Gaebler & Girolami 2013). Balance disorders lead to lower levels of activity and reduced patient independence (Hugues, Marco, Janiaud, Hue, Pires, Khademi, Cucherat, Bonan, Gueyffier & Rode, 2017). The functional goals of postural orientation are the active alignment of the body and head with respect to gravity (Bronstein & Pavlou, 2013) and postural balance - the coordination of motor strategies (Vasileva, Lubenova & Mihova, 2014). There are various systems that include postural control training, most of which focus on individual sensory systems (somatosensory sensation; vestibular, visual and proprioceptive sensation) and musculoskeletal components (range of motion, muscle strength, endurance, tone, biomechanical). relations) (Nikovska, 2018). The aim of the present study was to investigate the effect on postural control of 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 and late effects of postural kinesitherapy was performed, respectively on the 10th day, 1st month and 3rd month from the beginning of the program. The study shows a significant improvement in the static and dynamic balance of patients in the experimental group, which helps them to perform better in daily activities. In conclusion, the application of motor therapy aimed at improvements in postural control in patients with chronic stroke shows lasting improvements in quality of life, mobility and self-care. It is recommended that the motor program be modified according to the patient's needs. The individual focus and performing kinesitherapy in outpatient settings lead to an increase in the patient's motivation and the achievement of the set goals. Additional data: Clinically, stroke recovery is mainly associated with cerebral plasticity in the adjacent cortex (Lubenova 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 heminelect 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).