DOI: https://doi.org/10.22141/2224-0713.16.5.2020.209251

Classification of motor impairments after stroke in consequence of adaptive kinematic specificity

V.A. Lukashevich, V.V. Ponomarev

Abstract


Background. Clinical assessment of stroke, as a rule, is based on the use of the most adapted classifications of TOAST and ASCOD. Moreover, their general disadvantage is associated with their etiopathogenetic orientation, which sharply limits the clinical value of these classifications for subsequent medical rehabilitation. At the same time, the international classification of functioning, limitation of vital functions and health, on the one hand, is more applicable in rehabilitation medicine, and on the other hand, it is quite difficult in describing the complex problem of motor impairments in stroke. The aim of the study was to develop a classification of motor impairments in stroke. Materials and methods. The study involved 42 patients (25 men and 17 women aged 56.1 ± 4.7 years) in the early recovery period after stroke. As a comparison group, 27 healthy volunteers (16 men and 11 women aged 38.3 ± 5.5 years) were examined. Diagnosis of adaptive kinematics was carried out using the Teslasuit software and hardware, which included a control program and a smart suit with built-in inertial sensors. Postural testing consisting of four postural tests was used as a standardized diagnostic program. The study included 3 stages. At the first stage, screening was carried out for selection into the research group
using clinical scales: the Ashworth scale, the National Institutes of Health Stroke Scale, the modified Rankin scale, the Barthel index, the Rivermead mobility index, a 10-meter walk test, the stability of the vertical posture and the severity of fatigue. At the second stage, the diagnosis of adaptive kinematics was performed using a battery of specific test tasks and subsequent analysis of the average angular deviation of the main kinematic elements. During the third stage, the calculation of the total percentage of restricted mobility (TPRM) was performed with the identification of the median, upper and lower quartiles, which were markers of the TPRM corridor. Results. The value of the indicator forms the basis for a qualitative diagnosis of adaptive kinematics and a new classification of motor impairments in stroke according to severity: degree Ia — minimal disturbances (TPRM < 26 %); degree Ib — mild (TPRM — 26–38 %); degree IIa — moderate (TPRM — 39–51 %); degree IIb — significant (TPRM — 52–64 %); degree IIIa — severe (TPRM — 65–77 %); degree IIIb — extremely severe (TPRM > 77 % and higher).


Keywords


stroke; motor impairment classification; adaptive kinematics; pathobiomechanical phenotype; Teslasuit technology

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