{"id":36007,"date":"2020-12-30T10:42:45","date_gmt":"2020-12-30T10:42:45","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=36007"},"modified":"2021-03-19T06:20:39","modified_gmt":"2021-03-19T06:20:39","slug":"physical-rehabilitation-of-patients-after-ischemic-stroke","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol13no4\/physical-rehabilitation-of-patients-after-ischemic-stroke\/","title":{"rendered":"Physical Rehabilitation of Patients After Ischemic Stroke"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

Recently, vascular lesions of the heart and brain are becoming more and more common in the world1<\/sup>.\u00a0 Their formation is based on atherosclerosis2<\/sup>, arterial hypertension3<\/sup> and various metabolic disorders4<\/sup>.\u00a0 Statistics show that vascular pathology of the brain is becoming one of the leading causes of mortality and disability in different countries of the world5,6<\/sup>.\u00a0 Occlusion of the vessels supplying the brain is the initial link in the chain of adverse changes leading to gross disorders of neuronal metabolism, the development of their structural and functional changes, often ending in nerve cell death7<\/sup>.\u00a0 Acute or chronic ischemia of the brain tissue leads to a cascade of pathological reactions that can lead to the development of focal neurological deficit, progression of discirculatory encephalopathy, and often to the death of the patient8,9<\/sup>.<\/p>\n

The high prevalence of vascular diseases of the brain, high mortality from them, and the risk of developing disability against their background, often already at working age, make them one of the problems of special social significance10<\/sup>.<\/p>\n

It has been proven that the most complete recovery occurs in the first 3-6 months after a stroke.\u00a0 For this reason, the earliest possible start of rehabilitation is necessary, which would maximize the patient\u2019s condition, maximize his self-care skills, speed up his inclusion in society and improve his psycho-emotional state11,12<\/sup>.<\/p>\n

Given the severe consequences of a stroke, the high risk of disability against its background in the case of unsatisfactory rehabilitation in many respects seemed to be relevant to develop and test the author’s version of physical rehabilitation for patients who have recently suffered an ischemic stroke13,14<\/sup>.<\/p>\n

Objective: to evaluate the effect of the author\u2019s scheme of physical rehabilitation on the levels of blood cells during the early stages of the correction of motor skills in patients after ischemic stroke.<\/p>\n

Materials and Methods<\/strong><\/p>\n

The study was approved by the local ethics committee of the Russian State Social University on September 15, 2015 (protocol \u21169).<\/p>\n

The study was performed on patients aged 50 to 65 years who underwent treatment in the city clinical hospital named after S.P. Botkin in Moscow from December 2015 to December 2016 in the Department of Neurology with a diagnosis of “ischemic stroke” of various localization.<\/p>\n

To carry out rehabilitation according to the author\u2019s scheme, 44 people were selected who suffered an ischemic stroke a day ago.\u00a0 They made up an experimental group.\u00a0 From the day of admission to the hospital, all these patients received rehabilitation according to the author\u2019s scheme.\u00a0 The control group was recruited from 35 patients after an ischemic stroke who refused to carry out any physical rehabilitation.\u00a0 Drug therapy was standard in both groups and was no different.<\/p>\n

Author’s physical rehabilitation was carried out for 30 days and consisted of the following events:<\/p>\n

Position treatment was applied from the first day after a stroke and consisted of 3 main provisions of the patient: laying on the back, laying on the healthy side, laying on the affected side with the physiological position of the limbs.<\/p>\n

The use of passive ideomotor and active exercises.\u00a0 Passive exercises started simultaneously with the treatment by the position, performed on the sick and healthy side, at a slow pace, in full, in isolation in each joint with a number of movements from 2-4 to 8-10.\u00a0 Classes with idiomotor exercises were conducted for 10 minutes daily from the first day of admission to the hospital.\u00a0 They consisted in the presentation of the work with the hand and foot of the affected side while performing the same exercises on the healthy side.\u00a0 Active movements in the form of therapeutic physical culture began 5-7 days after ischemic stroke.\u00a0 These exercises always began to be performed with healthy limbs.\u00a0 This program was used in all patients of the experimental group for 40-45 minutes per day.<\/p>\n

Starting from the 10th day, the patients of the experimental group conducted standard exercises of breathing gymnastics by A. N. Strelnikova in the amount of 10 exercises per day, from the 15th day of the pack 15 exercises were carried out.<\/p>\n

Also, physiotherapeutic procedures were carried out with all patients of the experimental group, starting from the third week (from day 15), which included electrical stimulation of the affected limbs in combination with acupuncture.<\/p>\n

The motor activity of patients in the control group was carried out only at their request, in a certain mode, they refused a further course of physical therapy, their motor activity included walking, walking along the corridors of the department and self-care.<\/p>\n

In all patients under observation, the blood concentrations of leukocytes, erythrocytes and platelets were determined using an ADVIA 60 instrument (Bayer HealthCare LLC, USA).\u00a0 For the study, venous blood was used, which was taken on the first, fifth, tenth, fifteenth, twentieth, twenty-fifth and thirtieth days after a stroke.\u00a0The obtained digital values \u200b\u200bwere processed using Student’s criterion.<\/p>\n

Research Results<\/strong><\/p>\n

Patients taken under observation, who agreed to undergo rehabilitation according to the author’s method, in the outcome had a different number of red blood cells and platelets in the peripheral blood.\u00a0 Given this circumstance, patients with a high initial amount of red blood cells and platelets in the blood were monitored separately from patients who had their low concentrations.<\/p>\n

The physical rehabilitation of patients who had an ischemic stroke had a positive effect on their general condition and on the hematological parameters taken into account.<\/p>\n

It was found that the number of red blood cells in individuals from the experimental group who had a low concentration of red blood cells, by 10 days of observation tended to decrease relative to control values, subsequently continuing to decrease by 15 days and becoming significantly lower than the control (p<0.05) (table 1).\u00a0 By 20 days of the study, there was a significant growth (p<0.02) of red blood cells relative to the control while maintaining these changes until the end of the observation.\u00a0 This pattern, apparently, is due to the best adaptation of patients to current living conditions as a result of the use of author’s physical rehabilitation.<\/p>\n

Table 1: The effect of physical rehabilitation on the concentration of red blood cells in the peripheral blood of patients who initially had fewer red blood cells (\u00d71012<\/sup>\/l).<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
DatesofObservation<\/strong><\/td>\nControl group, <\/strong>\u041c<\/strong>\u00b1m, n=19<\/strong><\/td>\nExperienced group, <\/strong>\u041c<\/strong>\u00b1m, n=23<\/strong><\/td>\nValue\u0440<\/strong><\/td>\n<\/tr>\n
1 day<\/strong><\/td>\n3.9\u00b10.05<\/td>\n3.9\u00b10.06<\/td>\n0.21<\/td>\n<\/tr>\n
5 day<\/strong><\/td>\n3.8\u00b10.08<\/td>\n3.8\u00b10.01<\/td>\n0.15<\/td>\n<\/tr>\n
10 day<\/strong><\/td>\n3.9\u00b10.01<\/td>\n\n

3.8\u00b10.06<\/p>\n<\/td>\n

\n

0.10<\/p>\n<\/td>\n<\/tr>\n

15 day<\/strong><\/td>\n3.8\u00b10.01<\/td>\n3.8\u00b10.04<\/td>\n\n

0.05<\/p>\n<\/td>\n<\/tr>\n

20 day<\/strong><\/td>\n3.7\u00b10.02<\/td>\n3.9\u00b10.01<\/td>\n0.02<\/td>\n<\/tr>\n
25 day<\/strong><\/td>\n3.8\u00b10.02<\/td>\n3.9\u00b10.03<\/td>\n0.02<\/td>\n<\/tr>\n
30 day<\/strong><\/td>\n3.7\u00b10.02<\/td>\n3.9\u00b10.03<\/td>\n0.05<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

The number of red blood cells in individuals of the experimental group who had a large number of red blood cells in the outcome (table 2), tended to increase by 5 days of observation, then by 10 days of observation – to decrease relative to control values.\u00a0 Subsequently, this indicator continued to decrease and by 15 days it became significantly lower than the control (p<0.05).\u00a0 By 20 days of observation, there was a significant increase (p<0.02) in the number of red blood cells relative to the control, which remained until the end of the study.<\/p>\n

Table 2: The dynamics of the concentration of red blood cells (\u00d71012<\/sup>\/l) against the background of the rehabilitation in patients with a large initial concentration.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
DatesofObservation<\/strong><\/td>\nControlgroup, <\/strong>\u041c<\/strong>\u00b1m, n=16<\/strong><\/td>\nExperienced group, <\/strong>\u041c<\/strong>\u00b1m, n=21<\/strong><\/td>\nValue\u0440<\/strong><\/td>\n<\/tr>\n
1 day<\/strong><\/td>\n5.1\u00b10.04<\/td>\n5.0\u00b10.04<\/td>\n0.23<\/td>\n<\/tr>\n
5 day<\/strong><\/td>\n4.9\u00b10.05<\/td>\n4.9\u00b10.05<\/td>\n0.25<\/td>\n<\/tr>\n
10 day<\/strong><\/td>\n5.0\u00b10.05<\/td>\n4.9\u00b10.04<\/td>\n0.15<\/td>\n<\/tr>\n
15 day<\/strong><\/td>\n5.0\u00b10.05<\/td>\n4.8\u00b10.04<\/td>\n\n

0.05<\/p>\n<\/td>\n<\/tr>\n

20 day<\/strong><\/td>\n4.8\u00b10.04<\/td>\n4.8\u00b10.03<\/td>\n\n

0.05<\/p>\n<\/td>\n<\/tr>\n

25 day<\/strong><\/td>\n4.9\u00b10.05<\/td>\n4.8\u00b10.04<\/td>\n0.02<\/td>\n<\/tr>\n
30 day<\/strong><\/td>\n4.6\u00b10.05<\/td>\n4.8\u00b10.05<\/td>\n\n

0.02<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

It can be argued that the reaction of erythropoiesis to the author’s physical rehabilitation was more pronounced in patients with a large initial level of red blood cells.<\/p>\n

White blood cells in all patients of the experimental group had a downward trend by 5 days of observation.\u00a0 By the tenth day of observation, this dynamics became reliable (p<0.05).\u00a0 In the subsequent follow-up periods, patients until the end of the study maintained a reduced level of white cells in peripheral blood.<\/p>\n

Table 3: The dynamics of the number of leukocytes in the blood (\u00d7109<\/sup>\/l) in patients\u00a0<\/strong>after ischemic stroke.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
\n

Dates of Observation<\/strong><\/p>\n<\/td>\n

Controlgroup, <\/strong>\u041c<\/strong>\u00b1m, n=35<\/strong><\/td>\nExperienced group, <\/strong>\u041c<\/strong>\u00b1m, n=44<\/strong><\/td>\n\n

Value\u0440<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

1 day<\/strong><\/p>\n<\/td>\n

13.9\u00b10.26<\/td>\n13.1\u00b10.28<\/td>\n\n

0.22<\/p>\n<\/td>\n<\/tr>\n

\n

5 day<\/strong><\/p>\n<\/td>\n

13.2\u00b10.24<\/td>\n12.4\u00b10.25<\/td>\n\n

0.24<\/p>\n<\/td>\n<\/tr>\n

10 day<\/strong><\/td>\n13.1\u00b10.22<\/td>\n11.4\u00b10.21<\/td>\n0.05<\/td>\n<\/tr>\n
15 day<\/strong><\/td>\n12.8\u00b10.22<\/td>\n10.6\u00b10.18<\/td>\n\n

0.02<\/p>\n<\/td>\n<\/tr>\n

20 day<\/strong><\/td>\n12.7\u00b10.21<\/td>\n10.3\u00b10.18<\/td>\n\n

0.001<\/p>\n<\/td>\n<\/tr>\n

\n

25 day<\/strong><\/p>\n<\/td>\n

12.2\u00b10.21<\/td>\n9.9\u00b10.16<\/td>\n\n

0.001<\/p>\n<\/td>\n<\/tr>\n

30 day<\/strong><\/td>\n11.9\u00b10.39<\/td>\n\n

9.4\u00b10.17<\/p>\n<\/td>\n

\n

0.001<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

The data on the reaction of leukocytes in peripheral blood to the physical rehabilitation performed in patients after an ischemic stroke indicate the development of a decrease in inflammatory processes.<\/p>\n

In patients who had an initially low platelet count, there was a tendency to increase them within physiologically acceptable values \u200b\u200b(table 4).<\/p>\n

Table 4: Dynamics of platelet level (\u00d7109<\/sup>\/l) during rehabilitation in patients who had their initial low level.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
Dates of Observation<\/strong><\/td>\nControlgroup, <\/strong>\u041c<\/strong>\u00b1m, n=19<\/strong><\/td>\nExperienced group, <\/strong>\u041c<\/strong>\u00b1m, n=23<\/strong><\/td>\nValue\u0440<\/strong><\/td>\n<\/tr>\n
1 day<\/strong><\/td>\n177.1\u00b10.43<\/td>\n166.5\u00b10.20<\/td>\n0.33<\/td>\n<\/tr>\n
5 day<\/strong><\/td>\n167.8\u00b10.32<\/td>\n165.5\u00b10.16<\/td>\n0.27<\/td>\n<\/tr>\n
10 day<\/strong><\/td>\n178.8\u00b10.19<\/td>\n167.0\u00b10.12<\/td>\n0.15<\/td>\n<\/tr>\n
15 day<\/strong><\/td>\n186.6\u00b10.27<\/td>\n168.6\u00b10.41<\/td>\n0.07<\/td>\n<\/tr>\n
\n

20 day<\/strong><\/p>\n<\/td>\n

194.8\u00b10.29<\/td>\n165.5\u00b10.32<\/td>\n\n

0.05<\/p>\n<\/td>\n<\/tr>\n

25 day<\/strong><\/td>\n205.8\u00b10.18<\/td>\n169.1\u00b10.28<\/td>\n0.05<\/td>\n<\/tr>\n
30 day<\/strong><\/td>\n210.3\u00b10.14<\/td>\n170.0\u00b10.30<\/td>\n0.05<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Found a slight tendency to increase the level of platelets in the experimental group completely excluded their risk of thrombosis. Moreover, the increase in platelet count in the blood of individuals in the control group was more pronounced, but also did not go beyond the generally accepted norm.\u00a0 In patients who had an initially high platelet count, positive dynamics of their level was also noted against the background of their physical rehabilitation (table 5).<\/p>\n

\u00a0<\/strong>Table 5: Dynamics of platelet count (\u00d7109<\/sup>\/l) during rehabilitation in patients who had their initially high concentration.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
Dates of Observation<\/strong><\/td>\nControlgroup, <\/strong>\u041c<\/strong>\u00b1m, n=16<\/strong><\/td>\nExperienced group, <\/strong>\u041c<\/strong>\u00b1m, n=21<\/strong><\/td>\nValue\u0440<\/strong><\/td>\n<\/tr>\n
1 day<\/strong><\/td>\n292.0\u00b10.31<\/td>\n322.8\u00b10.42<\/td>\n0.16<\/td>\n<\/tr>\n
5 day<\/strong><\/td>\n290.0\u00b10.48<\/td>\n310.5\u00b10.48<\/td>\n0.10<\/td>\n<\/tr>\n
10 day<\/strong><\/td>\n286.5\u00b10.29<\/td>\n296.1\u00b10.34<\/td>\n\n

0.13<\/p>\n<\/td>\n<\/tr>\n

15 day<\/strong><\/td>\n284.8\u00b10.40<\/td>\n\n

285.1\u00b10.27<\/p>\n<\/td>\n

\n

0.07<\/p>\n<\/td>\n<\/tr>\n

20 day<\/strong><\/td>\n283.6\u00b10.51<\/td>\n278.3\u00b10.35<\/td>\n0.05<\/td>\n<\/tr>\n
25 day<\/strong><\/td>\n279.8\u00b10.26<\/td>\n264.0\u00b10.18<\/td>\n0.05<\/td>\n<\/tr>\n
\n

30 day<\/strong><\/p>\n<\/td>\n

276.5\u00b10.35<\/td>\n244.5\u00b10.24<\/td>\n\n

0.05<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

As the period after a stroke increased, the number of platelets in the blood of patients of both groups decreased, but in the experimental group this was much more pronounced.\u00a0 The achieved decrease in their number in the blood of patients of both groups indicated a lower risk of repeated thrombotic episodes.<\/p>\n

Discussion<\/strong><\/p>\n

The results obtained during the study confirm the prevailing scientific opinion that hematopoiesis is closely related to the general condition of the body and is sensitive to the appearance of pathology in any organ15<\/sup>.\u00a0 This is explained by the fact that with the development of disorders in the body, the level of hematopoietins in the blood and in the bone marrow inevitably changes.\u00a0 Moreover, the severity of these changes can be very individual16<\/sup>.\u00a0 There is reason to believe that with ischemic stroke, the regulatory effects of the brain on the bone marrow are very pronounced, which leads either to anemia with a tendency to thrombocytopenia, or to an increase in the number of red blood cells and platelets in the peripheral blood.\u00a0 However, in all cases, leukocytosis occurs, which is a consequence of the implementation of the response of the immune system to damage to brain tissue17<\/sup>.<\/p>\n

Conducted rehabilitation effects were able to boost the General condition of the patients and improved the accounted value in their blood. Taken under the supervision of the patients gave consent to undergo rehabilitation by the methodology, the outcome had in the peripheral blood of a different number of red blood cells and platelets. For this reason, patients with a high initial number of blood erythrocytes and platelets were assessed separately from patients who had low concentrations. Carried out their physical rehabilitation in all cases had a positive impact on their General condition and consider them hematological parameters. To explain the optimization of these parameters is possible when optimum levels of hematopoietic cells in the blood and normalization of production in the bone marrow formed elements of blood18,19<\/sup>. Developing changes to the end of the study contributed to a better adaptation of patients to the current conditions of life, improving they have a “margin of safety” in their bone marrow against the backdrop of the author’s physical rehabilitation.<\/p>\n

Found the response of erythropoiesis to the author’s physical rehabilitation was more pronounced in patients with higher baseline levels of red blood cells20<\/sup>. Previously, it was demonstrated that the extreme situation in humans, who had a peripheral blood source, a large number of red blood cells, leading to a significant decrease in their number, but at low initial level, this reduction is very small21<\/sup>.<\/p>\n

Held the author’s physical rehabilitation provided marked reduction in level of leukocytes in the peripheral blood of patients with ischemic stroke. This indicated the possibility of treatment applied to reduce the activity of mechanisms that support inflammation in the body22<\/sup>.<\/p>\n

In the blood of patients of the experimental group, regardless of the initial level of platelets is marked by a gradual optimization to physiologically acceptable values23<\/sup>. Revealed a decrease in the level of platelets in the blood of individuals of the control group of stroke survivors was much less pronounced than in the experimental group. Achieve changes in the number of platelets in the blood of patients of the experimental group observation indicated a real drop they have a risk of thrombotic episodes24,25<\/sup>, to thereby minimize they risk of recurrent stroke, emphasizing the preference of use of author’s physical rehabilitation after ischemic stroke26,27<\/sup>.<\/p>\n

Conclusion<\/strong><\/p>\n

The high prevalence of ischemic stroke, a serious risk of the occurrence on the background of disability put forward at the present time, the vascular pathology of the brain to the forefront of science. Conducting of post-stroke patients with physical rehabilitation copyright scheme optimized the level of their hematological parameters, regardless of their initial state. Data rehabilitation measures were provided in all patients with ischemic stroke, a gradual normalization in blood of quantity of erythrocytes, leukocytes and platelets. Developing changes to improve the trophic tissue of patients increased their overall reactivity and reduced the risk of recurrent ischemic stroke. Based on the results obtained, it can be considered the author’s version of post-stroke rehabilitation patients highly promising in terms of ensuring the normalization of the functioning of the bone marrow in post-stroke patients regardless of the source of their level of erythropoiesis, leucopoiesis and thrombocytopoiesis. It prevents such patients have anemia, weakening resistance and thrombophilia, which optimizes the overall condition and significantly improves the overall prognosis.<\/p>\n

Ethics Committee Resolution<\/strong><\/p>\n

The study was approved by the local ethics committee of the Russian State Social University on September 15, 2015 (protocol \u21169).<\/p>\n

Acknowledgement<\/strong><\/p>\n

The team of authors thanks the administration of the Russian State Social University for the opportunity to conduct research on its basis.<\/p>\n

Conflict of Interest<\/strong><\/p>\n

No conflict of interest is declared<\/p>\n

Sources of Financing<\/strong><\/p>\n

The study was conducted at the expense of the authors.<\/p>\n

References<\/strong><\/p>\n

    \n
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