Miedviedkova S. Rehabilitation among the patients after cerebral ischemic hemispheric stroke (diagnostics, treatment, prognosis)

The dissertation is devoted to the increasing of efficiency as for rehabilitation of patients in the early recovery period of cerebral ischemic hemispheric stroke (CIHS) by improving diagnostics, developing of criteria as for prediction its course and optimizing therapeutic measures. Complex clinical and paraclinical research was done in 375 patients in early recovery period of CIHS. The informative criteria for forecasting the severity of disability and the degree of self-service on the 180 day of CIHS have been developed, taking into account the combination of values of the extent of the lesion's center in the first 72 hours of CIHS and the level of neurological deficiency on the 10th day of the disease. The most informative parameters of the spectral analysis of bioelectric activity of the brain are determined for the evaluation of the severity of functional disorders on the 10th day of the CIHS. Informative criteria as for the prognosis of the relatively favorable output of the early recovery period of CIHS have been proved, which take into consideration the severity of neurohormonal disorders and they are based on the determination of the serum concentration of melatonin, serotonin level in plasma and their correlation on the 10th, 30th day of the disease. The expediency of evaluating as for the dynamics of serum level of VEGF-1 on the 10, 30 day of CIHS for prediction of the level of neurological deficiency on the 180 day of disease and further determination of optimal therapeutic and rehabilitation tactics are grounded. The informative criteria for forecasting the severity of disability and the degree of self-service on the 180 day of CIHS have been developed, which take into account the combination of values of serum NSE concentration and the level of neurological deficiency on the 10th day of CIHS. The expediency of determining the serum level of sPLA2 and low density lipoprotein for the 10th day of CIHS was evaluated to assess the risk of acute cerebrovascular events in the early recovery period of the disease in order to optimize treatment, rehabilitation and preventive measures. The expediency of using еntrop in patients with CIHS in the early recovery period has been proved to improve cognitive functions as well as to reduce affective disorders and asthenic syndrome. The complex application of the neurometabolic drugs such as сiticoline and аctovegin in patients with CIHS in the early recovery period has been substantiated in order to restore impaired neurological functions and improve the quality of life. The scheme of rehabilitation for patients with CIHS of four clinical and rehabilitation groups has been developed, which allows preserving the stages, sequence and continuity of treatment and rehabilitation measures, increases their effectiveness.