Method for complex rehabilitation of patients in early rehabilitation period of cerebral apoplexy

FIELD: medicine.

SUBSTANCE: with underlying pharmaceutical treatment, a complex program of rehabilitation actions involves combined therapeutic exercises (CTE) involving respiratory exercises and relaxing exercises and auto-training elements; the program is completed with the stage of visualisation that involves visual psyching-up of the visual process. That is followed by a dynamic propriocorrection using a reflectory loader. Further, a functional programmed electric stimulation of the neuromuscular apparatus is used. Depending on the manifestation of motor disturbances, a four- or sin-canal electric stimulation accompanying motor actions is performed according to the muscular excitation and contraction. The rehabilitation complex is completed in front of a mirror and involves doing the exercises of all joints of the upper limb and all planes with a healthy hand with inspecting a mirror image and visualising the motions to be performed with an involved hand. All combined exercises are followed by doing elementary relaxing motions. The quantity of the exercises is gradually increased to 400 per four sets.

EFFECT: method provides higher clinical effectiveness ensured by the integrated approach to the motor, cognitive and psychoemotional spheres.

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The invention relates to medicine, in particular to rehabilitation therapy, neurology, and can be used in complex rehabilitation of patients with stroke in the early rehabilitation period.

The structural component of recovery after a stroke is a brain plasticity - the ability to compensate for structural and functional disorders [Kharchenko, H.E., Klimenko M.I. Plasticity and regeneration of the brain. // Neurological journal. 2006; C, No. 6. P.37-45; Butefisch CM, Netz J, Webling M et al. Remote changes in cortical excitability after stroke. //Brain. 2003. Vol.126. No. 8. P.81-470]. Anatomical basis of plasticity is the cortical reorganization of departments, increase of efficiency of functioning of the surviving structures and active use of alternative top-down ways. Immediate implementation of these changes at the cellular (neuronal) level is in synaptic remodeling and neosynephrine. In some cases, not less important is the provision of extrasynaptic neuronal excitation transfer. The changes affect not only the neurons (they are marked by structural changes in dendrites and axonal sprouting), but also glial elements [ahno N., Dumoulin IV, ascension YEAR brain Plasticity and neuropsychiatric disorders. Materials of scientific-practical to the conference with international participation "Cognitive impairment during aging". Kyiv, 2007. S-80]. The processes of plasticity involve cortical and subcortical levels, including the thalamus, basal ganglia and structure of the brain stem.

There is a method of rehabilitation treatment after stroke pharmacological means: neurometabolic, nootropic, vasoactive, antihypoxic agents that improve blood flow, enhance metabolic processes in the CNS. However, the only pathogenetically reasonable time interval of application of neuroprotective agents is a therapeutic window. It is in these terms it is possible to interrupt the pathological chain of neurochemical reactions, potentially to prevent the death of neurons "ischemic penumbra"and, consequently, reduce the size of cerebral infarction and severity of neurological defect. As of today, the neuroprotective effect of any drug product at a later date cannot be regarded as conclusively proven [Gusev E.I., V.I. Skvortsova cerebral Ischemia. // M - 2001. - S; The national institute of neurological disorders and stroke rt-PA stroke study group.Tissue plasminogen activator for acute ischemic stroke. // New Eng J Med. - 1995. - V.333. - P.1581-1587]. "Pharmacological modulation of neuroplasticity does not exist..." - said Mnelson in his speech at the VII world Congress on neurorehabilitation (Melbourne, 2012).

In addition, the use of pharmacological agents ogran is constrained by the presence of various comorbidities, including allergic. Side effects, reduce the effectiveness of drugs as a result of their prolonged use exacerbate the problem of regenerative therapy using drugs.

The use of physical factors such as types of non-pharmacological treatment involves the fact that physiotherapy has a great choice of means of treatment, does not cause complications, allergic reactions and in most cases is well tolerated by patients. The main effects of physical therapy effects are: stimulation of blood and lymph circulation, analgesic, anti-inflammatory, antispasmodic, immune-stimulating, regenerating action. And as mentioned above, based on the restoration of impaired functions are the mechanisms of neuroplasticity. The influence of physical factors on cortical reorganization of departments, increasing the efficiency of the surviving structures of the brain is missing. Undoubtedly, physical therapy, traditionally used in the rehabilitation of post-stroke patients, it should be noted measures aimed at preventing spasticity and normalization of muscle tone, mild elegicheskogo syndrome (RTI, mineral wax therapy, cryotherapy, hydrotherapy, phonophoresis, percutaneous electrical stimulation of nerves and other). However, this treatment is is only symptomatic and unfortunately, the positive effect usually wears a short character. Moreover, evidence-based, controlled studies of the effectiveness of these techniques are not available.

Important role in the treatment and rehabilitation activities play different complexes of physiotherapy. Physical exercises are nonspecific irritant, because they stimulate the physiological processes in General, activate neurohumoral-hormonal mechanisms, enhance apparently with tendons and muscles, motor-visceral regulation of autonomic functions and backup mechanisms circulation [V. Moshkov. Therapeutic physical culture in the clinic of nervous diseases. M, Medicine, 1972, p.43-59]. To standard physical therapy include different combinations of exercises to increase range of motion and exercises with resistance, mobilization activity. However, the exercises, which are traditionally used in neurological departments shall be applied without regard to the ontogenetic process of formation of motor skills of a person, does not apply to programs based on neuromuscular "retraining". In addition, therapeutic physical training, as a rule, is a division of the body of the patient on the affected and unaffected side, some of the exercises used in unilateral paresis of the extremities,may even increase hemispheric asymmetry.

The closest way to the same destination to the claimed invention by a combination of traits and accepted us as a prototype is the way complex rehabilitation of patients in the early period of ischemic stroke with use of special physical exercises cognitive gymnastics. The method consists in the application of the dosed physical activity, including homolateral, heterolateral and cross-motion, auditory training, unidirectional and multidirectional movement of the eyes, tongue, and extremities. The complex consists of four groups of exercises: General developmental coordination (physical) exercises; exercises to stretch the neck muscles in the mode of post isometric relaxation; exercise, which increases the energy of the body; exercises for relaxation (see RF patent 2392916, CL A61H 1/00; publ. 27.06.2010).

A significant drawback of this method is the lack of ontogenetic principles of the recovery system of motor control, which is the main pathogenetic link all rehabilitation therapy. It is proven fact that the restored first axial muscles and proximal parts of the limbs, then the distal and fine motor skills. In the same way suggested exercises are given without taking into account the physiology and pathophysiology of functional is istemi movement in General and the system of regulation of movements, in particular. In addition, not attained, physiology and natural exercises for the body due to the gradual complication and sequence of their execution. While working with our patients is necessarily symmetrically from two sides both actively and passively, with a gradual increase of load. In the above method exercises are given in the form of General recommendations, sometimes difficult to understand for experts, not to mention the patients and their relatives, which greatly limits the applicability of this complex on the home stage. The ultimate goal of the method in the prototype is the improvement of cognitive functions. While musculoskeletal disorders were observed more than 85% of patients with stroke, largely preventing self-service. According to some authors, only 37% of patients retain the ability to walk immediately after cerebral catastrophe. Therefore, the recovery of walking skills, improve pace and movement speed should be considered as a priority. In an effort to restore only cognitive function in patients with severe motor impairment, restoration of motor skills, unfortunately, is not happening. Known fact is that the impact on the musculoskeletal field will contribute to the normalization and other f is NCCI, because the same transmitters participate in information transfer in the motor, sensitive, cognitive systems.

The only pathogenetically oriented point in a known method of rehabilitation of cognitive functions is to enhance interhemispheric relations and, accordingly, reduction of interhemispheric asymmetry. In our complex we offer more than simple, affordable, and most importantly, does not require certain efforts and proven visualization techniques and mirror therapy. Visualization - visual settings on a positive process. Thinking about their illness, people should always see yourself healthy, not sick, that is to be configured for a cure, not the disease. And working with the mirror when the patient performs movements with his good hand, there is an illusion about the execution of movements of the paretic limb. Reorganization in motor cortex occurs and when the mental representation of the relevant movements [Kami. A., Meyer, G., Jezzard, P., Adams, M.M., Turner R, Ungerleider L.G. // Nature, 1995, 377, 155-158]. Thus, with good recovery normalization of hemispheric asymmetry and eventually decline (or termination) of participation musculoskeletal departments undamaged hemisphere in the execution of the movements associated with the damaged hemisphere.

Some the and of the main manifestations of post-stroke neurological disorders, causing morbidity of patients are motor speech disorders, cognitive disorders. However, current research is only one of these aspects, while an integrated approach to solving this problem is absent. Our complex of rehabilitation measures aimed not only at the motor area, but helps to improve speech, cognitive, emotional and volitional functions.

The technical result of the claimed invention is to improve the effectiveness of rehabilitation therapy by developing a comprehensive program for the recovery of motor, cognitive, psychological deficit in patients in the early recovery period cerebral stroke. The consequence is an increase in motor activity by the end of inpatient treatment, enhancing self-service ability, quality of life improvement, process optimization medico-social rehabilitation and successful reintegration of patients into socially useful environment.

This object is achieved due to the fact that in the proposed method, the complex rehabilitation of patients in the early recovery period cerebral stroke on the background of medical treatment dosed physical load.

According the invention carry out the comprehensive plan of progressive rehabilitation measures, in the course of which first apply the special complexes of physiotherapy (physical therapy). The course of rehabilitation includes 10 lessons, lasting 40-45 minutes, where the introductory part lasts 10 minutes, the main part is 20-25 min, the final part with performing breathing exercises and relaxation exercises with elements of auditory training for 10 minutes, complete a mandatory stage of the visualization, in which patients perform visual setting on a positive process.

Then perform dynamic proprietarily using reflex-loading device.

Next apply programmable functional neuromuscular electrical stimulation apparatus using a hardware-software complex "Akord-Multisystem". However, depending on the severity of musculoskeletal disorders conduct a four - or six-channel correction movements, during which the intervention carried out by electric stimulation of the gluteal muscles, quadriceps femoris, triceps legs, the rear portion of the deltoid muscle in combination with a three-headed muscle of a shoulder on the side of paresis.

Complete complex of special exercises in front of the mirror, the so-called "mirror therapy". According to which the patient is healthy hand performs exercises all with whom the composition of the upper limb and in all planes, watching the reflection in the mirror, mentally imagining that performed the movements he makes it her arm. Each exercise do 50 times in four sets, after each set of exercises perform basic movements for relaxation; gradually the number of completed exercises lead up to 400 in four approaches.

In addition, when conducting a special complexes gymnastics exercise will agree with respiratory performed under the account, with different speed and duration of inhalation and exhalation, make them smoothly, quickly, in various combinations: 1) breath quick, sharp 1-2 account; slow exhale for 4 counts; 2) slow breath for 4 counts; exhale quick 1-2 account; 3) the breath calm 2-4 accounts; exhale too; 4) the breath stops 2-3 times; exhale calm, slow, without stopping. In the absence of independent movement in the paretic limb (or their significant limitations) after each exercise with a healthy side perform passive movements with the help of the instructor gymnastics in a slow, smooth pace, isolated in each joint in all planes with gradual movements from the very simple to the goals and objectives to complex and composite.

In addition, dynamic proprietarily carried out by reflex at the times of the device - costume "Gravistat"in which lessons are conducted on General principles: introduction, main and final part. Moreover, the introductory part includes breathing exercises and exercises for small and medium-sized muscle groups and joints, the main part includes walking, doing exercises from the main part of the simple exercise therapy and classes at the gym: treadmill, stair-master with steps of different height and width, stair stepper, stationary bike. In the final part, after removing the suit, patients perform breathing exercises, relaxation exercises and visualization. The course consists of 10 lessons from 40 to 60 minutes

In addition, during the programmable functional electrical stimulation neuromuscular electrical stimulation apparatus gluteal muscle exercise in the first half of the support phase. Correction extension in the knee joint is carried out by stimulation of the quadriceps femoris in the first half of the support phase, and in the second half of the mobile phase. Correction of plantar flexion in the ankle joint is realized by means of electrical stimulation of calf triceps in the middle third (2/3) of the reference phase. In that case, if you have a sagging or equinus foot, correction of dorsiflexion in the ankle joint by means of stimulation of the anterior tibial muscle at the end of the support and on the ale portable phases. When expressed frontal and sagittal rocking torso apply electrical stimulation Sacro-spinalis muscles on both sides at the end of the anchor and the first half of the portable phases. The more intense the exposure is subjected to the healthy side. For correction of hand movements used stimulation of the deltoid and triceps muscles of the shoulder. And stimulation of flexor or extensor forearm produce in each case individually: if there are weaknesses, more pronounced in the flexors, respectively, provide electrical stimulation of the flexor muscles. In the presence of spasticity, abnormal flexion install brushes, intervention carried out by electric stimulation of their antagonists - extensors of the forearm. Electrical stimulation is carried out at the end of reference and within a portable phases, and hypotension stimulation is carried out at a current frequency of 65 Hz, spasticity - 85 Hz. However, if you have a low pain threshold and discomfort reduce the frequency to 50 Hz; the rate of electrical stimulation includes 10 sessions 25-30 min daily (excluding weekends).

The achievement of the technical result is driven by the fact that, along with the use of standardized principles of treatment (medical therapy, massage) are special complexes Leche the service of physical education, applied rehabilitation technology using the method of dynamic proprietarily using reflex-loading device and method programmable functional neuromuscular electrical stimulation apparatus and method "mirror therapy".

It is proved that the integral part of the effective complex restorative treatment and rehabilitation of post-stroke patients are methods pathogenetically justified therapy. Recovery mechanisms resemble the formation of the child in ontogenesis: restored first axial muscles and proximal parts of the limbs, then the distal and fine motor skills. First encounter bilateral, large movement, reminiscent of the diagonal with the transfer of the limb in the opposite direction, then fine.

All of these characteristics formed the basis of our original complex methods of rehabilitation of patients in the early recovery period cerebral stroke. Component part are dosed, rhythmically repetitive active and passive exercise, exercises on special machines, machines that help restore mobility and range of motion in the joints, relieving movements and increasing muscle strength, improving the special and General physical health, increase ventilation, improve the basic physical qualities.

I. physiotherapy Exercises are held on the following principles:

- incremental movements from the very simple to the goals and objectives to sophisticated;

- from movements in most large and small joints with increasing force and frequency of repetitions;

the amplitude is gradually increased from the optimum to physiological;

- the multiplicity of repetitions of movements at each joint to gradually increase up to 10 times (to start with 4-6 times);

- classes are necessarily symmetrically from two sides (if necessary with the paretic hand passively);

- active and passive movements performed in a slow, smooth pace, isolated in each joint in all planes.

Elementary movement in the joints are the alphabet of any complex movements that can always be decomposed into elements, the final of which will be movement in any joint (Pthreshold, 1888), helps restore mobility and range of motion in the joints, relieving movements and increase muscle strength, improve special and General physical performance, increase ventilation, improve the basic physical qualities

therapy includes 10 lessons, each lasting 40-45 minutes daily, 5 times per week, except the output is different. The duration of each exercise for 1 to 2 minutes In the absence or significant limitation of independent movements are passive motion with the help of the instructor LFK.

In the process of study patients sequentially pass through three main periods: introduction, main and final.

Technique gymnastics (with elements of methodology "Balance therapy").

The introductory part includes breathing exercises and exercises for small and medium-sized muscle groups and joints. Most physiological is full breath when you inhale chest expands successively in the vertical direction due to the lowering of the diaphragm and in anteroposterior and lateral directions in the simultaneous movement of the ribs upward, toward the front and sides. It is recommended to perform exercises under the account, with different speed and duration of inhalation and exhalation produced smoothly, quickly, in various combinations: 1) breath quick, sharp 1-2 account; slow exhale for 4 counts; 2) slow breath for 4 counts, exhale quick 1-2 account; 3) the breath calm 2-4 accounts; exhale too; 4) the breath stops 2-3 times; exhale calm, slow, without stops, etc.

I.P. sitting, standing. The head turns left and right with gaze fixation on the opposite side. Lifting and lowering of the shoulders, alternating breeding and hand. Digitaliseerimine. Flexion and extension in the elbow joints. Movement in the joints of the hands and feet of the wrist and ankle (flexion, extension). Breathing exercises. The rolling of the foot from heel to toe and back again.

During the primary partition is training (General, special) effects on the body of the patient. Also the physical exercise will agree with breathing exercises.

1. I.P. Sitting, standing. Abstraction healthy hands shoulder - cast. Abstraction (active/passive) paretic hand - cast. Flexion/extension of the shoulder joint first turn, then coordination of both hands. Raise the arms through the sides up. Circular motion in the shoulder joint forward/backward (I.P. sitting, standing, hands to shoulders).

2. I.P. Standing face sideways to the gym wall, grip hands at the shoulder line. Lead a healthy leg in the hip joint - cast. Abstraction paretic leg in a cast. Flexion/extension of healthy feet. Flexion/extension of the paretic leg.

3. I.P. Sitting, standing. Flexion/extension of the healthy leg in the knee joint. Flexion/extension (active/passive) in the knee joint of the patient's legs.

4. I.P. back to the gym wall, grip hands on line of the hip joint (be sure that the back of the neck, back, pelvis, legs were tightly pressed against the wall,chin parallel to the floor). Step foot forward, moving the center of gravity on the "front" leg to bend. Shoulders divorced, shoulder blades together, tummy tuck, bearing on the whole foot, chin parallel to the floor. The same with the other leg. Pay attention to the straightening of the leg at the knee joints.

5. I.P. Standing. To raise your right hand, take the left ear. Lift your left hand, take your right ear. Raise two hands, to cross, to take up his ears.

6. I.P. Standing. Leg bent in all joints up to 90 degrees abduction knee to the side. The same movement with the other leg. Exercise turn to start then right, then left leg, doing each option 5-6 times.

7. I.P. Standing. Raise two hands, to cross, to take up the ears with simultaneous squat without lifting the heels from the floor, knees apart. If you need to keep one hand on the bar of wall alternately.

8. Exercise Speculum. At the expense of time to raise her right arm. The hand in the position policybase before him, brush at eye level on the median plane of the body with the palm facing you. On account of the two to return to its original position.

9. Similarly panel. 7, only the movement is performed with the left hand.

10. Exercise "Balerina". At the expense of time to raise bent right arm and right leg. The hand in the position policybase before him, brush at eye level on the median plane of the body with the palm to the ebe; right leg bent in all joints up to 90 degrees abduction knee to the side, the right foot placed on the level of the left knee; the two is to return to its original position.

11. Similarly UPR, only the movement is performed with the left hand and left leg.

12. At the expense of time to raise your right hand and right leg (the hand in the position policybase before him, brush at eye level along the Central axis of the body, palm facing you; leg bent in all joints up to 90 degrees abduction knee to the side, the right foot placed on the level of the left knee); at the expense of two - turn body to the left 90 degrees at the toe of the left foot, keeping the position of all of the limbs relative to the longitudinal axis); to remain in this position (the hand in front of face, stop at knee level, standing on the left leg, left hand down). If necessary, supported by an exercise physiologist (by relying on the paretic leg) or healthy hand to adhere to the crossbar.

13. On account of time's right hand, take a side and down to turn the palm backward (moving 45 degrees, to prevent the extension arms back and to the side of his hand back, right leg bent in all joints up to 90 degrees abduction knee to the side, the right foot is at the level of the left knee; the two is to return the right hand to its original position (the hand is the position of policybase in front of him, brush at eye level along the Central axis of the body, palm facing you)

14. At the expense of time to straighten right leg with abduction in the hip joint in the direction of 45 degrees, toe of the foot itself (the hand in the position of policybase before him, brush at eye level along the Central axis of the body, palm facing you); the two is to return to its original position.

15. On account of time's right hand, take a side and down to turn the palm backward (moving 45 degrees, to prevent the extension arms back), at the same time to lower and straighten the leg with abduction in the hip joint at a 45 degree angle (not touching the surface of the support); the two is to return to its original position (the hand in the position policybase before him, brush at eye level along the Central axis of the body, palm facing you, the leg is bent in all joints up to 90 degrees abduction knee to the side, the right foot is at the level of the left knee).

Exercises 12-15 repeat with the left hand to turn the torso to the right.

16. At the expense of time to raise your right hand and right leg (the hand in the position policybase before him, brush at chest level along the longitudinal axis of the body, palm facing you, bend the leg in all joints up to 90 degrees abduction knee to the side, the right foot placed on the level of the left knee); at the expense of two - turn body to the left 90 degrees at the toe of the left foot on the count of three - rotate the torso to the right 90 degrees at the toe of the left foot; at the expense of four - to drop the right hand and leg.

17. Similarly panel. 16, only the movement begins with the left hand and left leg, and the rotation of the trunk is to the right, return left.

18. At the expense of time to raise your right hand and right leg (the hand in the position policybase before him, brush at chest level along the longitudinal axis of the body, palm facing you, bend the leg in all joints up to 90 degrees abduction knee to the side, the right foot placed on the level of the left knee); at the expense of two - turn body to the left 90 degrees at the toe of the left foot; on the count of three - lower right arm and leg. At the expense of time to raise his left arm and left leg (the hand in the position policybase before him, brush at chest level along the longitudinal axis of the body, palm facing you, bend the leg in all joints up to 90 degrees abduction knee to the side of the foot left foot to place on the level right knee); at the expense of two - turn body to the left 90 degrees at the toe of the right foot; on the count of three - lower left arm and leg. Then you change the left and right sides, but the twist torso to conduct in one direction. Two times a full circle to the left two times a full circle to the right.

The result of this complex leads to the activation of links between centres, control movements, develops nespolo the ary interaction.

In the final period are breathing exercises and relaxation exercises with elements of auto-training. Visualization - visual settings on a positive process - is also one of the main elements of this complex. Thinking about their illness, people should always see yourself healthy, not sick, that is to be configured is not a disease, and for a cure!

II. The next step in the comprehensive recovery program are training in therapeutic costumes "Gravistat".

Dynamic proprietarily is carried out by means of reflex-loading device "Gravistat". The principle of the method is the impact on the brain patterns of enhanced flow skorrigirovanna proprioceptive pulsation generated in the process of fulfilling the patient active and combined (active-passive) movements in reflex-loading device "Gravistat".

The suit allows you to specify individually metered load to regulate it during the course of rehabilitation treatment. Its complex effect on the musculoskeletal system can be briefly reduced to three effects:

- create (or increase) of the longitudinal load on the skeletal structure;

increasing resistive muscle load movement;

increasing the intensity of proprioceptive offer is ncacii.

The basic elements of costume "Gravistat" power thrust regulating the compression load directed along the long axis of the body, and correcting the position of the individual motor segments of the trunk and lower extremities. For each patient individually calculated compressive load to dosing and selection depending on the body weight of the patient, the source mobility, age and tolerance to physical loads (i.e. endurance). Overcome the additional resistance increases the activity of postural muscles, which leads to improving the health of the person. Correctly selected axial load and functional correction of the position of the motor body segments rotary ("torque") rods to cause flow normalized activity directed against receptors articular and muscular-ligamentous apparatus in the Central nervous system. Under the influence of this thread happen transformation activity of functional systems of antigravity and other analyzer systems of the brain, which is the basis for the development of physiological movements, emotions and will, to some extent, intelligence and speech of the patient.

The basic principles of practice in suits "Gravistat":

the lessons take place no earlier than one hour after e is s;

during classes held regular monitoring of blood pressure, heart rate;

- assessed subjective feelings;

- individually for each patient selected axial load and mode of practice;

- classes in the costume starts with the minimum load, which is gradually increased from lesson to lesson, leading up to 40-50 min;

in the process of study patients are consistently the same three main periods: introduction, main and final.

The introductory part includes breathing exercises and exercises for small and medium-sized muscle groups and joints. Partly come from the exercise of previously presented complex physical therapy.

During the primary partition is training (General, special) effects on the body of the patient. Part of the exercise is taken from the main part of the simple physical therapy.

In the course of employment in NPCs " Gravistat" should be taught:

- the correct upright position of the head and body relative to the supporting surface;

the movement of the center of gravity of the upper body on the supporting leg;

- moving unsampled feet;

- correct statement of the foot at the end of phase transfer legs;

- ability to maintain posture while resting on each leg;

- equal distribution of weight on both feet;

the direction of movement and rhythm.

Approximate complex panel is of ineni.

1. Standing on stabilometer without lifting the feet from the support, moving the center of gravity from one foot to the other.

2. Standing, face, side, back to the Swedish wall, feet hip-width apart, moving the center of gravity on the right, the left leg.

3. Standing sideways to the right to the Swedish side, the abduction of the left leg back with simultaneous internal rotation of the body and the stroke of the left hand forward. The same the other side.

4. Back at the wall, feet hip-width apart, the patient shifts weight from one foot to the other, producing a short step forward, hands grip the top level of the pelvis. Exercise promotes a sense of support and proper movement of the body.

5. Training in the dual position of support on the front heel and toe of the rear foot. The patient makes swinging movement, putting to fully support one or the other leg.

6. Walking on the spot.

7. Walking on a flat surface with the face, back, forward, side steps left, right side (if necessary support, insurance).

8. Walking on a level surface with turns.

9. The walk along the trace path on special markup.

10. Walking at a slow pace on the treadmill (face forward).

11. Walking at a slow pace on the treadmill shaky steps left, right, sideways.

12. Walking on a special marking on the treadmill (trace track) - m is Glennon pace. With the help of this exercise is implemented correct statement of the foot.

13. The ascent and descent by steps of different height and width.

14. Over the items of different height, width and volume.

15. The ascent and descent of stairs (stair-master): added steps, face forward.

16. Training on simulators: stepper, stationary bike.

We should dwell on this point, highlighting its importance. Cyclic rotational movement of the lower extremities prepare the patient to perform the essential functions of the walk and are the type of muscular work, which promotes the training of the cardiovascular and respiratory systems, increases the capacity of the aerobic source of energy products when performing work [G.P. Arutyunov, Vershinin, A. A., Rozanov, A.V. and other Effects of regular physical activity for a period of circulatory failure in patients with postinfarction period // of breast cancer. - 1999. - V.7. No. 2. - P.23-28. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for cardiac rehabilitation programs. Champaign, IL: Human Kinetics, 1991: 9-15]. However, the seat and the rotational motion of the feet and hands, standing and walking are certain stages in the gradual verticalization and rehabilitation of the patient with its own characteristics.

It is known that two walking, pedaling bike is an open oscillatory system in which the moments with the wounded and energy conversion to the greatest extent due to the interaction of limb support [vitenson A.S. The study of biomechanical and neurophysiological patterns of normal and pathological human walking. - The dissertation of Dr. med. Sciences. - M., 1982]. It was at this point are provided as the rise and progress (dynamic component), and stability of the body position (static component). This point is realized mainly due to the work of the main developing the most power extensor muscles of the limbs, body, weakness (even minimal) can lead to gross violations of motion. All this means that one type of energy is largely converted into the other, and through this transformation can long be maintained moving body (the individual segments of the body) of a person. Hence arose the pathogenetically substantiated the need for practice in suits "Gravistat" on the bike, during which it is mandatory for each patient, the monitoring of main indicators: blood pressure, heart rate, measured subjective feelings. The classroom is gradually increased.

In the final part, after removing the suit, patients perform breathing exercises and relaxation exercises. All patients are visualization - visual setting on the positive process (introducing yourself healthy).

III. The application of the method is unctionally programmable electrical stimulation (FPAS) neuromuscular apparatus using a hardware-software complex multi-channel programmable electrical stimulation "Akord-Multisystem" - the next step in solving the problem of rehabilitation of post-stroke patients.

You need to focus on that priority building program neurorehabilitation, gradually complicating the task and increasing the burden on the patient. In between the main complex patients receive drug therapy, physiotherapy courses of treatment.

therapy includes 10 sessions 25-30 min daily (excluding weekends).

theoretical basis of the method FPAS is theory of the Central spinal generator of the cyclic locomotion (CPG Central Pattern Generators) and cortical plasticity [MacKay-Lyons M Central Pattern Generation of Locomotion: A Review of the Evidence. Phys Ther. Vol.82, No.1, January 2002, pp.69-83]. According to this theory in the spinal cord found a chain of neurons that perform the function generator shahania. She is responsible for the alternation of periods of excitation and inhibition of different motoneurons and can operate in automatic mode [Kosak, MS, Reding M.J. Comparision of partial body - weight - supported treadmill gait training versus aggressive bracing assisted walking post stroke // Neurorehabil Neural Rep. 2000. Vol.14. No. 1. P.13-19. Peurala S. et al. Gait characterisrics after gait - oriented rehabilitation in chronic stroke // Restor Neurol Neurosci. 2005. Vol.23. No. 2. P.57-65]. Basic pattern of locomotor program walk starts touch apperently from the skin and the muscle and joint receptors. Thus, activation of spinal generator need is and apperentice from foot (reliance on foot) and from large proprioreceptors (muscle and tendon receptors hips). Based on this afferention was supposed to secondary cortical reorganization involving the ipsilateral hemisphere and undamaged kortiko-spinal tract [Daly J, et al. A Randomized Controlled Trial of Functional Neuromuscular Stimulation in Chronic Stroke Subjects. Stroke, 2006; 37; 172-178; Tong Ky et al. Ambulation training for patients with acute stroke by cyclic Gait Trainer walking exercise and Functional Electrical Stimulation (FES): a pilot study. 10th Annual Conference of the International FES Society. July 2005 - Montreal, Canada].

Neurophysiological essence of the method FPAS is the exact time line of artificial programs (through stimulation) and natural (when you try random efforts) excitation of the muscles in the engine acts of man (vitenson A.S., 2000). In other words, the electrical stimulation of muscles during locomotion is in exact accordance with the natural excitation and muscle contraction during motor action. Method FPAS combines the properties of three global strategies clinical rehabilitation - therapeutic physical training (kinesitherapy), physiotherapy and functional orthotics (vitenson A.S., 2003).

Implemented FPAS using a Hardware-software complex multi-channel programmable electrical stimulation "Akord-Multisystem" (development MFD "Statkin", Russia).

The choice of the adjustable movements and muscles for each patient is made individually, with the compliance with its ultimate goal. As you know, during normal walk the electrical activity of the muscles is concentrated in a certain phase of the motor act, corresponding to the phases of development of the greatest efforts. The function of the extensor muscle, concentrated in the first and second third reference phase, aimed at moving the total center of mass and the provision of stability during walking, whereas the work of the flexor muscles in the mobile phase has mainly corrective in nature, since it contributes to the clarification of the positions and movements of individual segments of the legs [vitenson A.S., Mironov E.M., Petrushansky K.A., Skoblin A.A. Artificial correction of movements in pathological walking. M., 1999, 503 S.]. Accordingly, correction of the extensor movements of the lower limbs and trunk in the reference phase is a priority, whereas the question about the correction of flexion movements in carrying phase is decided depending on the severity of paresis and delivered the ultimate goal. Depending on the severity of musculoskeletal disorders is four - or six-channel correction movements. It should be noted that the correction movements when walking is only effective if the function of muscles is estimated at 2-3 points.

Offered by us intervention in most cases carried out by electrostimulator and gluteal muscles, the quadriceps femoris, triceps legs, the rear portion of the deltoid muscle in combination with a three-headed muscle of a shoulder on the side of paresis. While electrical stimulation of the gluteal muscles is carried out in the first half of the support phase. This correction significantly improves the stability of the patient during walking, increases the support function of the paretic leg. Correction extension in the knee joint by stimulation of the quadriceps femoris occurs in the first half of the support phase, and in the second half of the mobile phase. Correction of plantar flexion in the ankle joint by electric stimulation of the triceps muscle of the calf is in the middle third (2V3) reference phase. In that case, if you have a sagging or equinus foot, correction of dorsiflexion in the ankle joint by means of stimulation of the anterior tibial muscle at the end of the support and at the beginning of the portable phases. In both the last corrections increases stability when walking, increased locomotor function through the development of additional points in the phase front and rear shocks.

When expressed frontal and sagittal rocking body uses electrical stimulation of the Sacro-spinalis muscles on both sides (thus more exposed should be healthy side) at the end of pornoi and the first half of the portable phases.

For correction of hand movements used stimulation of the deltoid and triceps muscles of the shoulder. Stimulation of flexor/extensor forearm is in each case individually. When there is weakness, more pronounced in the flexors, respectively provide electrical stimulation of the flexor muscles. In the presence of spasticity, abnormal flexion install brush - intervention carried out by electric stimulation of their antagonists - extensors of the forearm. Electrostimulation is carried out at the end of reference and within a portable phases.

In accordance with the above-proposed scheme, the physician selects the corrective action to the appropriate muscles to impose the electrodes fixed elastic tapes. The pacemaker is securely fixed to the belt attached to the patient. The pacemaker connects the communications cable which connects it with the interface unit and the computer. Then all the connected TV is set to the stimulation program. Double stepping cycle in the complex "Akorda" is divided into 16 phases. Electrostimulation of muscles is made within the specified start and end phase dual step cycle. During the procedure, the pacemaker provides on each channel, according to a certain law of the spine, the alternation of the excitation signal and pauses. The excitation signal is a sequence of current pulses with a frequency set by using software from 50 to 85 Hz.

So, for the electrical stimulation is applied to the sequence of electrical pulses of rectangular shape amplitude 0-100 mA duration of output signal 50-250 ISS, with a range of pulse repetition rate 50-85 Hz. If hypotension stimulation is carried out at a current frequency of 65 Hz, spasticity - 85 Hz. However, if you have a low pain threshold and discomfort reduce the frequency to 50 Hz.

The intensity of the electrical stimulation should be sufficient to implement corrective actions and yet be within comfortable (painless) zone. The effect of stimulation over time weakens due to the phenomena of adaptation of muscles to electrical stimulation. The patient alone or with the help of a doctor performs the setting of the energy levels on all channels, bringing the performance up to 100%. Changes in the total amplification is carried out using the appropriate keys on the pacemaker.

Temporary program install sensors synchronization knee angles, mounted on one of the lower extremity. The mode of ES in the walk comes to corrective training for 25-30 min in t the value of 10 sessions.

Upon completion of the procedure, the patient will perform breathing exercises, relaxation exercises.

IV. The final stage of the comprehensive rehabilitation program in the context of a single day are "classes with a mirror", the so-called "mirror therapy".

The principle of sensory corrections should one interesting thing. Familiar and common to think that the execution of arbitrary motion is entirely a matter of musculoskeletal systems of the body: muscles - as a direct motors, motor nerves that transmit in the muscles orders (pulses) to move from the spinal cord and brain; finally, the so-called motor centers of the brain, whence come these orders impulses to the muscles. It turns out that things are not so, and sensitive system of our body are loaded when performing any motion not less than the motor. The way to do limb managed only one: continuously from the first moment vigilantly to reconcile the movement with the reports of the senses and lead it all the time to check the appropriate corrections. Motor skill of even the most simple and repetitive motion cannot be motor formula or motor stamp, as erroneously thought before. In sensitive parts of the brain that perform sensory correction, also also is highlighted in the formation of the skill is not some kind of constant formula adjustments. Finally, and by the movements of the skill you should always have some degree of adaptive variability, which is growing from the bottom up, from level to level. Therefore, and in sensitive systems of the brain is deposited and accumulates in the formation of the skill is not once and for all permanent template, and a peculiar, special maneuverability. Sensitive brain system gradually skilfully primazivaetsya to do instant translations from that language, which come in the brain sensations and impressions about the course of the movements, on the language of the correction motor impulses, which required them to send one or the other muscle. This translation from the language of feelings into language corrections we call Perestroikas nerve impulses. Thus, the most rational and properly set such training will be in which with the lowest cost of labor will be covered most well-thought-out variety of sensations and will create the best conditions for a meaningful way to remember and assimilate all these feelings (N.A. Bernstein, 1991).

Innovation in the 40-ies of the twentieth century, the ideas and the results of numerous studies Noobenstein and formed the basis of mirror therapy.

In the mirror, nothing changes. But the illusion is created because when considering repositioning themselves in the place covered by the Oia you deploy themselves around a vertical axis, and not around the horizontal. In fact, the mirror is changed to reverse the sequence in which the points are on the straight, perpendicular to the surface of the mirror. If you stand on the mirrored floor, your axis "top-down" perpendicular to the plane of the mirror and in the reflection before remains front, left side the left side, but the head is facing down and feet up. If you stand sideways to the mirror, your axis "right-left" perpendicular to its surface. When the reflection in the mirror head will remain at the top of the legs at the bottom, before will remain front, but the right and left sides will swap places. If you stand facing the mirror, at the reflection of your head will remain at the top of the legs at the bottom, but the front and back sides will swap places. Since your mirror reflection of the left hand side, opposite to where it was if you went through the mirror and turned around, we say that a mirror reverses left and right. In other words: looking in the mirror, the person creates a coordinate system in which you can mentally rotate in three-dimensional space our reflection by 180° around a vertical axis and to combine itself and a reflection of [This right, left the world. Gardner M., 1967].

It is proved that the reorganization in the motor cortex occurs when mental representation the AI of the respective movements. Wherefore, working with the mirror when the patient performs movements with his good hand, there is an illusion about the execution of movements of the paretic limb, also increases the activity of corresponding areas of the brain.

So, the patient is seated healthy sideways to the table, which is perpendicular to the surface of fixed mirror, size 45 cm×50 cm the healthy hand, the patient puts on the table in front of the mirror, and has paralyzed for the reflecting surface. Throughout the procedure (about 20 minutes) the patient is looking only in the mirror, watching the movements of the healthy hand (paretic same limb remains invisible), visualizing that the running movement he makes it her arm.

We considered fulfillment of motion in all joints of the upper limb and in all planes that extends activatable zone representation hands in the motor cortex. And as the hands are conventionally located near the area of the legs, it is not excluded the impact on the motility of the legs, by activation synaptogenesis.

Suggested exercises:

For the shoulder:

- lifting and lowering of the shoulders;

- abduction of the shoulder to the horizontal level (for convenience, the hand crank is in the elbow joint) - cast-motion carried around the sagittal axis;

- around the frontal axis is moving forward bending and backward motion - extension (also for easy bending of the elbow);

- around a vertical axis of rotation of the shoulder inward and outward - pronation and supination;

and in conclusion - circular motion in the shoulder joint.

Performing each movement is necessary to recreate the image of a healthy, robust man, inwardly feel this way. Concentrating on the reflection in the mirror, imagine that the movements are done in exactly the paretic limb, in full and with extraordinary ease.

For the elbow joint:

- flexion and extension in the elbow joints (around the frontal axis);

- pronation and supination (around vertical axis).

For the wrist joint:

the flexion and extension performed in the sagittal plane;

- cast (ulnar deviation) and abduction (radial deviation)occurring in the frontal plane;

- turns the brush inwards and outwards (performed with the forearm).

For the wrist joints and the finger joints:

- the opposition of thumb to the little finger and the other fingers;

- maximum breeding fingers, bringing;

- clenching-unclamping fingers into a fist. First, the emphasis on the fingers clenching - practiced grasping movements, then unclamping - practicing throwing motions;

- consistently compressible fingers from the little finger to the big a few times, and then from the forefinger to the little finger. Then shake hands, relax the muscles;

- rotational motion of the brush (a clenched fist) in a circle of maximum diameter;

- imitation letters;

- simulation of the capture of the object, moving it;

Each exercise is to do 50 times in four approaches. After each set of elementary movement relaxation. Gradually the number of completed exercises to bring up to 400 in four approaches. The proposed method is easy to perform and requires no special equipment, it is suitable to practice at home, what is especially important, after discharge of patient from hospital.

To achieve effective results of rehabilitation treatment should follow the optimal sequence and rational allocation procedures during the day. The proposed complex of rehabilitation measures should be carried out in the sequence shown above, as this addresses the problem of modeling physiological hierarchical control of motor functions of the nervous system. This complex is designed to meet the current t is ebouaney numerous rehabilitation concepts and approaches namely "task-oriented approach", according to which therapeutic measures aimed at restoring certain motor tasks, and not on the recovery of individual movements and functions, as was done earlier, in the classical models of recovery.

All patients included in the program of comprehensive rehabilitation, conducted a neurological examination using a 6-point scale assessment of muscle strength (Belova A.N., 2000; Braddom R., 1996), CT and/or MRI scan of the brain; USGS great vessels. Surveys were conducted twice: at inclusion in the study and on the 14th day from the start of treatment.

The criteria for the effectiveness of therapeutic effects were:

- scale YOUR;

- the Montreal scale assessment of cognitive functions (ILAC);

the questionnaire of quality of life SF-36 Health Status Survey" (Russian version created and recommended MZIKI);

sample Schulte;

- determination of the level of domestic activity index Bartel (Barthel ADL index);

- the index of mobility Riverbed (Rivermead Mobility Index);

- scale sustainability standing (Standing Balance);

- walk with time and distance (Timed Walking Test);

- the index of the walk Hauser (Hauser Ambulation Index);

- scale reactive and personal anxiety Spielberg;

- Beck depression inventory;

- personal questionnaire Bekhterevsky Institute (BEAN);

- stabilometry (standing, from the am and my eyes closed).

During our research when conducting rehabilitation activities none of the patients was not observed deterioration in cerebral hemodynamics.

Clinical example 1.

Sick Kalinkin Viktor Vladimirovich, 42, was admitted to the neurological Department Bureau No. 2 with complaints of weakness and limitation of movements in the right limbs, numbness of the right half of the body, difficulty walking and movement. Diagnosis at admission: Hemorrhagic stroke in the basin of the left middle cerebral artery (22.07.2012,) with the formation of intracerebral hematoma in the left temporal-parietal region, right-sided hemiparesis deep in his hand, and moderate in the leg, the early recovery period. Background disease: Hypertension 3 tbsp., risk 4, CHF 1, FC 2.

In neurological status: C. paresis VII n. right; right-sided hemiparesis: expressed in his hand, moderate in the leg. Muscle strength is reduced in the right hand proximally to 3.56, distal up to 3.06 in the right leg to 3.56. Muscle tone was increased in the right limbs along the pyramidal type. Gait - semipretioase, using assistive devices. Dry. refl. With a/K and h/D>S (+) s-m Babinski on the right. Hemihypesthesia pain sensitivity on the right. Dysarthria.

Assessment of severity of neurological defect: Test Index of mobility Rivermead: 12/15. Test odba registration time and distance: the distance: 360 m; elapsed time: 6 min; walking speed: 1 m/s, using auxiliary tools; Test Index walk Hauser (Hauser Ambulation Index) - 3 points; the index Bartel - 90; assessment of quality of life on the scale of YOUR 4 points.

In the study of cognitive status, emotional and personal sphere using neuropsychological examination revealed the following: high situational and personal anxiety (51 and 55 points, respectively); no depression scale Beck (9 points); mixed type of the illness (algopaticheskih, neurasthenic); 26 points on ILAC-test. When analyzing the quality of life revealed a decrease in all the scales.

On the 14th day of hospital stay improved overall health, mood, became more active, mobile, stable when walking; regressed speech disorders; increased volume of active movements in the paretic limb muscle strength in the hand increased to 4 points, n/a up to 4.5 points; improved walking distance, increased the speed and tempo of movement. Test the Index of mobility Riverbed 15/15. Test Walking time and distance: distance traveled: 474 m; elapsed time: 6 minutes walking Speed: 1,32 m/s (without using control sticks); Test Index walk Hauser - 2 points; the index Bartel - 100; assessment of quality of life on the scale of YOUR 7 points.

Spade is the n neurasthenic features. Saved arroptions disorders (care of illness at work) with the characteristics sensitivity (excessive concern about the possible adverse impression can make on others information about their disease), decreased performance on scales of depression Beck, reactive and personal anxiety of Spielberg. The study of quality of life according to the test SF-36 showed a significant improvement in the following indicators: "physical functioning" (65 b.), "General health" (60 B.), "social functioning" (38 B.), "the physical health component" (36 B.), "mental health component" (31 B.).

In addition, a comparative study of stabilographic data before and after a course of rehabilitation found a significant improvement: reduction of the area of statokinesigram, reducing the average speed of the center of pressure reduction in the frontal and sagittal variations, the magnitude of the random variations in different directions (forward/backward, right/left).

Clinical example 2.

Patient Shubin Arkady O., 49 years old, was admitted to the neurology Department of the Regional clinical hospital №2 of Rostov-on-don with complaints of weakness and limitation of movement of the left extremities, impaired walking and movement. Diagnosis at admission: Ischemic stroke in b is sane right MCA (03.08.12) with mild left-sided hemiparesis, dysfunction of the limbs and walk, early recovery period. Background disease: Hypertension Art. III, risk 4. HSN 1, FC 2.

In neurological status: FMN - C. paresis VII n. on the left side. Volume of active movements restricted in the left extremities. Muscle strength is reduced in the proximal hands up 4 points in the distal Sep. up to 3 points; n/to 3-3,5. Muscle tone is slightly elevated along the pyramidal type on the left. Gait semipretioase. In the Romberg instability, without storenote; coordinatorsee sample: right - performs satisfactorily; left - implementation is difficult because of paresis. Tendon reflexes with b/a, n/a S>d m Babinski (+) to the left. Hemihypesthesia left. Ascension, emotionally labile. Pelvic function controls.

Assessment of severity of neurological defect: Test Index of mobility Rivermead: 10/15. Test Walking time and distance: the distance: 215 m; elapsed time: 6 min; walking speed: 0,6 m/s; Test Index walk Hauser (Hauser Ambulation Index) - 3 points; the index Bartel - 85.

In the study of cognitive status, emotional and personal sphere using neuropsychological examination revealed the following: moderate situational and personal anxiety; mixed type of the illness (obsessive-phobic). Drew my attention to detail is their sharp decline in all parameters, determining the quality of life scale SF-36: 1) PF (physical functioning) - 0; 2) RP (the influence of physical conditions on role functioning (work everyday activities) - 0; 3) BP (intensity of pain and its impact on the ability to carry out everyday activities) - 21; 4) GH (General health) - 40; 5) VT (vitality (implies feeling full of energy or, on the contrary, limp) - 30; 6) SF (social functioning) - 12; 7) RE (the influence of emotional state on role functioning) - 0; 8) MN (self-esteem mental health, describes the mood (depression, anxiety, General indicator of positive emotions) - 68; PH (total score Physical health component") - 21; MN (total score Physical health component") - 31,56. On the scale of YOUR patient quality of life was assessed at 1 point.

On the 14th day of hospitalization, the patient noted improvement in General health, mood; in addition, the expanded volume of active movements in the paretic limbs, muscle strength increased in the proximal arms up to 5 points, in the brush to 4.5 points; in the proximal legs up to 4.5 points, in the distal to 4 points; improved walking distance, increased the speed and tempo of movement. Test the Index of mobility Riverbed 14/15. Test Walking with registratie the time and distance: the distance: 340 m; elapsed time: 6 minutes walking Speed: 0,94 m/s; Test Index walk Hauser - 4 points; index Bartel - 100; assessment of quality of life on the scale of YOUR 5 points.

Flattened anxious-phobic features. The study of quality of life according to the test SF-36 showed a significant improvement in the following indicators: "physical functioning" (40 B.), "General health" (70 b.), "viability" (65 b.), "social functioning" (38 B.), "emotional role" (33 b.), "the physical health component" (31 B.), "mental health component" (42 B.).

In addition, decreased time find numbers for tables Schulte; increased the number given by patient associations (nouns) for 1 min, improved attention and conceptualization of the Montreal scale. Also improved stabilographic parameters.

Thus, after the course of a comprehensive rehabilitation treatment of patients reported a positive trend in the motor area (increase of muscle strength in the paretic limb), increasing the speed and pace of walking, improving the performance of functional and household tasks (index increase Bartel). Improved neurodynamic indicators of mental, cognitive processes (improved voluntary attention (decrease search time numbers for tables Schulte)); when assessing the display of the ' attention and conceptualization of the Montreal scale improvements were also noted. When evaluating the data, the associative test were recorded increase in the number given by patient associations (nouns) for 1 min, Repeated study of short-term oral-aural memory (learning 5 words) demonstrated significant dynamics play a larger number of words. It was noted a positive impact on the emotional-volitional sphere, which was reflected in the increase of mental activity, interest, motivation for recovery; reduce anxiety. In addition, the study of quality of life as a predictor of the effectiveness of comprehensive rehabilitation of patients in the early recovery period cerebral stroke showed a significant improvement in physical, psychological and social functioning of patients.

The above clinical examples fully confirm the success of our methods. Among patients who had offered us a complex of rehabilitation measures, improvements come not only in physical, but also emotional, and cognitive areas, improving indicators of the quality of life of patients.

Summarizing the above, we can conclude that the use of the above complex in a rehabilitation program can effectively solve many difficult questions patients preesseaderly stroke, by correcting a wide range of not only motor but also cognitive, emotional-volitional disorders.

Thus, it becomes a real implementation of the tasks set by the international community for the successful integration of patients in socially constructive environment, the return to the usual employment.

The claimed method can be used in neurological and rehabilitation departments of hospitals, health centers, dispensaries for patients after cerebral infarction. It also supports playback of elements of the complex and at home that retains the principle of continuity and stages of the rehabilitation process.

1. The method of complex rehabilitation of patients in the early recovery period cerebral stroke by holding the medicated treatment dosed physical load, characterized in that conduct a comprehensive program consistent rehabilitation measures, which in the beginning used complexes of physiotherapy (physical therapy), and the course of therapy includes 10 lessons, lasting 40-45 minutes, where the introductory part lasts 10 minutes, the main part is 20-25 min, and a final part, performing breathing exercises and relaxation exercises with elements of auditory training for 10 minutes, complete a mandatory stage of the visualization, Ho is e which patients exercise the visual setting on a positive process; then perform dynamic proprietarily using reflex-loading device; further apply programmable functional neuromuscular electrical stimulation apparatus using a hardware-software complex "Akord-Multisystem", in this case, depending on the severity of musculoskeletal disorders, conduct a four - or six-channel electrical stimulation during motor action in accordance with the excitation and contraction of muscles, while stimulating: gluteus, quadriceps muscle of the thigh, triceps muscle of the lower leg, the rear portion of the deltoid muscle in combination with a three-headed muscle of a shoulder on the side of paresis; and complete complex rehabilitation exercises in front of a mirror, in which the patient is healthy hand performs exercises in all joints of the upper limb and in all planes, watching the reflection in the mirror, mentally imagining that performed the movement it produces exactly the patient's hand, with each exercise do 50 times in four sets, after each set of exercises perform basic movements for relaxation; gradually the number of completed exercises lead up to 400 in four approaches.

2. The method according to claim 1, characterized in that when conducting complexes of exercise therapy exercise will agree with dehat lname, running under the account, with different speed and duration of inhalation and exhalation, make them smoothly, quickly, in various combinations: 1) breath quick, sharp 1-2 account; slow exhale for 4 counts; 2) slow breath for 4 counts, exhale quick 1-2 account; 3) the breath calm 2-4 accounts; exhale too; 4) the breath stops 2-3 times; exhale calm, slow, without stopping, however, in the absence of independent movement in the paretic limb after each exercise with a healthy side, perform passive movements with the help of the instructor gymnastics in a slow, smooth pace, isolated in each joint in all planes with gradual movement from simple to complex, and combinations thereof.

3. The method according to claim 1, characterized in that the dynamic proprietarily carried out by reflex-loading device - costume "Gravistat"in which lessons are conducted on General principles: introduction, main and final part, and the introductory part includes breathing exercises and exercises for small and medium-sized muscle groups and joints, the main part includes walking, exercises, basic gymnastics and exercises at the gym: treadmill, stair-master with steps of different height and width, stair stepper, stationary bike; in the final part, after removing the suit, patientimpact breathing exercises, relaxation exercises and visualization; the course consists of 10 lessons from 40 to 60 minutes

4. The method according to claim 1, characterized in that during the programmable functional electrical stimulation neuromuscular electrical stimulation apparatus gluteal muscle exercise in the first half of the support phase, the correction extension in the knee joint is carried out by stimulation of the quadriceps femoris in the first half of the support phase, and in the second half of the mobile phase; correction of plantar flexion in the ankle joint is realized by means of electrical stimulation of calf triceps in the middle third reference phase; in that case, if you have a sagging or equinus foot, correction of dorsiflexion in the ankle joint by means of stimulation of the anterior tibial muscle at the end of the support and at the beginning of the portable phases; when expressed frontal and sagittal rocking torso apply electrostimulation Sacro-spinalis muscles on both sides at the end of the anchor and the first half of the portable phases, more intensive exposure to expose the healthy side; for the correction of hand movements used stimulation of the deltoid and triceps muscles of the shoulder, and the stimulation of flexor or extensor forearm is carried out in each case individually: if slabs and, more pronounced in the flexors, respectively, provide electrical stimulation of the flexor muscles; in the presence of spasticity, abnormal flexion install brushes intervention carried out by electric stimulation of their antagonists extensor of the forearm, the electrostimulation is carried out in the end and support for portable phases, and hypotension stimulation is carried out at a current frequency of 65 Hz, spasticity - 85 Hz, but if you have a low pain threshold and discomfort reduce the frequency to 50 Hz; the rate of electrical stimulation includes 10 sessions 25-30 minutes each day, excluding weekends.