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https ://doi.org/10.29013/ELBLS-21-4-12-14
Badashkeev Mikhail Valeryevich, candidate of pedagogical sciences, psychologist OGBUZ "Bokhansky RB" E-mail: [email protected] Shoboev Andrey Eduardovich, neurologist, OGBUZ "Bokhansky RB" E-mail: [email protected]
POST STROKE REHABILITATION: NEUROPLASTICITY PROCESSES IN RECOVERY TREATMENT AFTER ISCHEMIC STROKE
Abstract. This article discusses various aspects of neuroplasticity in patients who have undergone ischemic stroke; we attribute the dynamics and ambiguity of this process to certain features. We emphasize the process of dynamism, its ambiguity of involving the structures of the opposite hemisphere of the brain in the process of recovery. Terms from the moment of stroke and activation of various parts of the brain in the post-stroke period are considered. The authors pay attention to neurorehabilitation and a multidisciplinary approach in the restorative treatment of patients who have undergone ischemic stroke. It is also noted that rehabilitation measures should be started in the early period of stroke, immediately after confirming this diagnosis and stabilizing the condition of the patient.
Keywords: ischemic stroke, functional recovery, acute cerebral circulation disorder, post-stroke rehabilitation, neuroplasticity, neurorehabilitation.
The problem of ischemic strokes today is global is growing exponentially. Until 1990, 2 works were for medical and social services, this problem is more published, from 1990 to 2000-43, and over the next associated with a high percentage of disability, and 10 years - more than 600 publications [5, 134-143]. complete social maladaptation of patients. There For the first time, the concept of plasticity of the are 16 million cases of cerebral circulation disorders nervous system was introduced by A. Bethe when he (hereinafter, MMC) in the world every year, with described the operation to suture the tendon of the an average of 70-75% of patients showing residual wrist flexor with the peripheral ends of the paralyzed events. Often, even with intensive treatment using extensor of the fingers, i.e. two parts of one split musa full range of rehabilitation measures, 30-40% of cle, usually functioning as a whole, were given two patients have low dynamics, which certainly leads antagonistic purposes. By the plasticity of the ner-to incapacity, therefore, a person becomes disabled vous system, the author understood its adaptability for 40-50 years. to changed conditions due to a change in peripheral
In recent decades, ideas about the neurofunc- afferentization [4, 82-93].
tional features of the CNS have been rapidly chang- Well-planned rehabilitation measures are impor-
ing. According to the electronic database PubMed, tant in the management of patients after a stroke.
the number of publications devoted to this problem They can be of varying degrees effective for 80% of
POST STROKE REHABILITATION: NEUROPLASTICITY PROCESSES IN RECOVERY TREATMENT AFTER ISCHEMIC STROKE
patients after PMC, 10% have complete spontaneous recovery of impaired functions, and only 10% of patients have rehabilitation measures that are unpromising [6]. The concept of neuroplasticity plays a key role in the rehabilitation of patients with neurological diseases. Various methods and technologies of restorative treatment are based on knowledge about mechanisms and processes of plastic restructuring [7; 8]. Experimental studies of recent years have made it possible to postulate one of the important principles of the biological phenomenon of neuroplasticity, which is subsequently actively used in determining the program of rehabilitation treatment of patients with diseases of the central nervous system (CNS): the emergence, existence and effective use of neuronal connections directly depend on their functional activity [9].
Thus, the concept of neuroprotection involves the continuous adaptation of a neuron to new functional conditions, which is the sum of all mechanisms directed against damaging factors. These processes are regulated by hormones, neurotrophic growth factor (BDNF), neurotransmitters, cytokines, electrophysiological activity, stress, etc. An example of neuroplasticity in early ontogenesis is the fact that in children under 10 years of age the dominant hemisphere (in 85% of cases) in the formation of speech and figurative functions is the right hemisphere, and later these functions go to the left [6].
Thus, in the process of ontogenesis, not only the structure of mental functions changes, but also their anatomical organization. At the same time, if normal lateralization is disrupted when one of the hemispheres is affected, then the speech function moves to a healthy hemisphere, which becomes dominant in verbal function. In adults, an example of neuroplasticity is an increase in certain brain structures associated with professional activities. In professional translators, this is an increase in the left temporal lobe, in musicians - the primary motor zone, the temporal lobe and the anterior part of the corpus call sum, in taxi drivers whose professional activities
are associated with spatial orientation, the size of the hippocampus. It was established that neuronal plasticity is accompanied by changes in the structure of astroglia and astrocytes, an increase in contact zones between astrocytes and synapses, an increase in the number and area of dendrite processes, an increase in the number of synapses, in addition, it is accompanied by other activating effects both in nervous and glial tissues [6].
We, in turn, put hope in the neuroplasticity of the brain, which is critical for functional recovery and therefore a significant reduction in disability. In general, by neuroplasticity, we mean a certain ability of the cells of the nervous system to regenerate anatomically and functionally change. At the same time, neuroplasticity processes are associated not only with the neurons themselves, but also qualitative, quantitative changes in neuronal connections and glial elements, the development of new sensorimotor pathways and integrations in the central nervous system in the recovery period of treatment [1; 2].
In our particular case, Citicolin plays an important role due to good tolerability and combinability, as well as neuroprotective exposure. In earlier scientific papers, we described a combined combination of Citicolin and Cortexin, which undoubtedly gave positive dynamics to the process of functional recovery after ischemic stroke [3]. In this study with Citikolin monotherapy, we observed the following pattern: all patients tolerated Citikolin well, all patients showed positive dynamics. That, in principle, is confirmed by other researchers on this issue [8, 1390].
Thus, the use of knowledge of the features of neuroplasticity leads to a significant effectiveness of rehabilitation therapy during the recovery period. The determining factor is the integrity of the white matter or damage to the descending motor pathways, and not the motor cortex itself, since no significant dynamics were observed when the motor cortex sections were affected. Which in principle indicates a sufficiently high neuroplastic potential of white matter of the conducting structures of the
CNS even with severe damage compared to large the functional activity of the corticospinal tract for
cortical lesions, and the prognostic significance of subsequent recovery of post-stroke deficiency.
References:
1. Badashkeev M. V. Neuroplasticity processes in the recovery period after ischemic stroke // mat. междунар. науч.- prakt.konf. "Breakthrough Research: Challenges, Limits and Opportunities" / Rev. ed. A. A. Sukiasyan.- Voronezh, 2020.- P. 264-265.
2. Badashkeev M. V. Neuroplasticity as the basis for recovery from ischemic stroke // mat. междунар. науч.- prakt.konf. "The development of integration processes as a goal and condition for increasing the competitiveness of science" / otv. ed. A. A. Sukiasyan - Orenburg, 2020.- P. 172-175.
3. Badashkeev M. V. Combined neuroprotection in recovery cognitive functions // Materials in the International Scientific Conference "Science and innovations 2021: development directions and priorities" / "Auspublishers" publishing house - Australia, Melbourne. 2021.- P. 186-189.
4. Bethe A. Plasticity (adaptability) of the nervous system // journal. The successes of modern psychology.- T. 3.- No. 1. 1934.- P. 82-93.
5. Galanin I. V., Naryshkin A. G., Gorelik A. L., Tabulina S. D., Mikhailov V. A., Skormets T. A., Lobzin S. V. Current state of the problem of neuroplasticity in psychiatry and neurology // Bulletin of the Northwest State Medical University named after I.I.- Vol. 7.- No. 1. 2015.- P. 134-143.
6. Damulin I. V., Ekusheva E. V. Clinical significance of the phenomenon of neuroplasticity in ischemic stroke. Annals of Clinical and Experimental Neurology.- No. 10(1). 2016.- P. 57-64.
7. Yekusheva E. V. Sensomotor integration in central nervous system damage clinical and pathogenetic aspects. Autoreferat diss. Doc. honey. sciences.- Moscow, 2016.- 48 p.
8. Kadykov A. S., Shakhparonova N. V. Rehabilitation after a stroke. Russian Medical Journal - Moscow,-No. 11(25). 2003.- 1390 p.
9. Wasaka T., Kakigi R. Sensorimotor Integration. In: Magneto encephalography. From signals to dynamic cortical networks. Eds. S. Supek, C. J. Aine / Berlin, Heidelberg: Springer-Verlag, 2014.- P. 727-42.
