Features of Movement Recovery in the Paretic Lower Limb in Patients after Stroke

Aim. To identify the features of movement recovery performed on a horizontal plane by the foot of the affected lower limb and associated changes in maintaining body balance in patients with mild to moderate central paresis, and to identify factors for their improvement.

Design. Clinical prospective randomized interventional longitudinal pilot study.

Materials and methods. The study included 115 patients with ischemic stroke in the carotid basin, who received medical assistance according to standards and clinical guidelines. The patients were divided into two groups: the main group (I), in which stabilometric training was included in the rehabilitation measures, and the comparison group (II), in which it was not performed. Additionally, both groups were divided into subgroups with mild and moderate paresis depending on the degree of strength loss in the foot. At the beginning and end of the course, all patients underwent testing of available movements on a horizontal plane along the proposed rectilinear trajectory to the limitations corresponding to the image on the monitor screen reflecting the game situation. Foot movements were performed sequentially in the frontal plane by abduction and adduction in the hip and flexed knee joints of the paretic lower limb and in the sagittal plane by extension in the knee with simultaneous flexion in the ankle joint in combination with adduction, abduction and rotation of the foot. Then the direction was changed, and the patients flexed the knee and extended the ankle joint of the paretic lower limb. Only patients from Group I practiced these movements during repeated training. Functional testing of the motor sphere, stabilometric tests were conducted, emotional-volitional and cognitive disorders that could affect the effectiveness of the training were identified.

Results. Targeted work on repeated performance of given rectilinear single-plane movements over a short course (10 sessions of 10 minutes 4 times a week) was accompanied by an improvement in balance, primarily in individuals with a moderate degree of muscle strength reduction in the foot. Improvement of stabilometric indicators in Group I reflected the effectiveness of the training. Sensitive indicators were the speed of movement of the center of pressure, area and energy intensity of the statokinesiogram. When analyzing the factors influencing the correction of movements, it was found that the greatest effect was produced by high motivation, preservation of cognitive functions, absence of anxiety and depression with active inclusion of visual control in the implementation of the motor act throughout the rehabilitation course.

Conclusion. Motor rehabilitation with targeted correction of foot movements in patients with central paresis of the lower limb after stroke led to an improvement in balance in a short time, especially in patients with a moderate degree of muscle strength loss in the foot. Patients with mild foot paresis in stroke should be recommended a training course in practicing foot movements, consisting of at least 6 sessions of 10 repetitions each, and with moderate paresis — of 8 sessions of 10 repetitions. Correction of rectilinear single-plane movements in the frontal plane is formed later by one training session than in the sagittal plane. 

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