RU2789261C1 - Method for rehabilitation of upper limbs of stroke patients, using biological feedback and virtual reality elements - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to a method for rehabilitation of upper limbs of stroke patients, using biological feedback and virtual reality elements. When implementing the method, a patient is provided with equipment for content reproduction with virtual reality elements and a motion capture system with sensors. A software package containing content formation elements with virtual reality elements and control elements is loaded. Then, in parallel with the reproduced content with virtual reality elements, the patient performs movements of the damaged part of the body, while registering an amplitude of movements and duration of their execution and organizing biological feedback. In this case, the patient is additionally provided with a system of electrodes. A software package is used, containing a regulatory route for performing movements described in a database of rehabilitation protocols and functionally combining the system of electrodes, equipment for content reproduction with virtual reality elements, the motion capture system, and an electronic computer for control of them, as well as input and processing of information. At the same time, a doctor inputs information about a recommended volume of movements into the electronic computer. Then, the patient is provided with equipment for content reproduction with virtual reality elements, the motion capture system with sensors, and the system of electrodes. The motion capture system is calibrated, during which, using a marker, a position of a lower starting point of the movement of the damaged upper limb is recorded, which is also the origin of coordinates in the motion capture system. The doctor selects a rehabilitation protocol from the database, and, during rehabilitation procedures, the patient, in parallel with the reproduced content with virtual reality elements, performs movements of the damaged upper limb according to the rehabilitation protocol, when the motion capture system registers, in real time, an amplitude of movements in large joints, % of angular deviation relatively to the lower starting point of movement of the damaged upper limb, and duration of movements. At the same time, biological feedback is organized starting from the second rehabilitation procedure, when, in case of deviation of the movement of the damaged upper limb from the regulatory route of movement, multi-channel asynchronous local percutaneous muscle electrical stimulation is performed by means of the system of electrodes, so that an actual route of movement of the damaged upper limb corresponds to the route of movement, established by the doctor, in the form of a regulatory route adjusted taking into account the recommended volume of movements.

EFFECT: efficiency of rehabilitation procedures is increased due to organization of automatic, stable, and objective biological feedback, which does not fully control patient’s motor activity, but only corrects a volume and nature of movements, use of a software package, which allows a doctor to independently configure a complex and order of rehabilitation procedures, including personalized adjustment, as well as making changes in the course of rehabilitation procedures and rehabilitation protocols.

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Description

The invention relates to medicine, neurology and rehabilitation, to rehabilitation treatment in the areas of mechanotherapy, physiotherapy, orthopedic care and biofeedback therapy (BFB) of stroke patients.

The existing recommendations established by the order of the Ministry of Health of the Russian Federation dated November 15, 2012 No. 928n “On Approval of the Procedure for Providing Medical Care to Patients with Acute Cerebral Circulatory Disorders” include the following high-tech assessments of the neurological profile: correction of an altered psycho-emotional state, correction of pathological muscle tone. The use of high-tech methods of rehabilitation in the restoration of labor functions and the patient's psycho-emotional state is one of the developing areas of rehabilitation.

There is a known method for the rehabilitation of patients who have undergone an institute, with a pronounced loss of control over motor skills, swelling, pain and spasticity (see Norouzi-Gheidari N, Archambault PS, Monte-Silva K, et al. Feasibility and preliminary efficacy of a combined virtual reality, robotics and electrical stimulation intervention in upper extremity stroke rehabilitation J Neuroeng Rehabil 2021;18(1):61 Published 2021 Apr 14 doi:10.1186/s12984-021-00851-1), in which a personalized upper limb rehabilitation program includes the following: procedures: (1) performing movements by the patient under the control of an automated system; (2) exercises using virtual reality elements to practice traction and gripping movements without assistance; and (3) neuromuscular electrical stimulation to facilitate opening and closing of the arms. The frequency of use of each procedure during the intervention was determined according to the individual's hand recovery potential.

The disadvantage of the known solution is the need to use a robotic system that performs the exercises specified by the doctor, as a result of which the patient lacks motivation, which reduces the effectiveness of biofeedback in the rehabilitation process.

As the closest analogue, a method for the rehabilitation of the upper limbs of stroke patients using biofeedback and elements of virtual reality was adopted, in which the patient is equipped with equipment for playing content with elements of virtual reality and a motion capture system with sensors, a software package is loaded containing elements of formation content with elements of virtual reality and controls, then the patient, in parallel with the reproduced content with elements of virtual reality, performs movements with the damaged part of the body while registering the amplitude of movements and the duration of their implementation and organizing biofeedback (see RF patent No. 2432971, IPC A61N 1/00 , A61M 21/02, 2011).

The disadvantages of the closest analogue are:

- limited movement of the patient in a virtual environment due to the fixation of accelerometers in the pelvic region and torso, which limits the scope;

- the lack of the possibility of mechanotherapy or therapeutic physical culture with the joints of the limbs;

- weakening of motivation and psycho-emotional rehabilitation, since the use of a dolphin model in a virtual environment as an avatar does not allow the patient to associate himself with the character;

- instability and subjectivity of biofeedback based on eye contact.

The task to be solved by the claimed invention is the development of an effective method for the rehabilitation of patients while providing automatic, stable and objective biofeedback.

The technical result, which manifests itself in solving the problem, is expressed in increasing the efficiency of rehabilitation procedures due to the following factors:

- organization of automatic, stable and objective biofeedback, which does not fully control the patient's motor activity, but only corrects the volume and nature of the movement;

- the use of the software package allows the doctor to independently adjust the complex and order of rehabilitation procedures, including personalized settings, as well as make changes to the course of rehabilitation procedures and rehabilitation protocols.

The problem is solved by the fact that the method of rehabilitation of the upper limbs of stroke patients using biofeedback and elements of virtual reality, in which the patient is equipped with equipment for playing content with elements of virtual reality and a motion capture system with sensors, downloads a software package containing elements content with elements of virtual reality and controls, then the patient, in parallel with the reproduced content with elements of virtual reality, performs movements with the damaged part of the body when registering the amplitude of movements and the duration of their execution and organizing biofeedback. a complex containing a normative route for performing movements described in the database of rehabilitation protocols and functionally combining a system of electrodes, equipment for reproducing content with elements of virtual reality, a motion capture system and an electronic computer for their control, as well as input and processing of information, and the doctor enters information about the recommended amount of movement into the electronic computer, after which the patient is equipped with equipment for playing content with elements of virtual reality , a motion capture system with sensors and a system of electrodes, then the motion capture system is calibrated, in which the position of the lower starting point of the movement of the injured upper limb, which is also the origin of coordinates in the motion capture system, is recorded using a marker, the doctor selects a rehabilitation protocol from the database and during rehabilitation procedures, the patient, in parallel with the reproduced content with elements of virtual reality, performs movements of the injured upper limb according to the rehabilitation protocol when registered by the motion capture system in real time amplitude of movements in large joints, % of the angular deviation relative to the lower starting point of movement of the injured upper limb and the duration of the movements, while biofeedback is organized starting from the second rehabilitation procedure, when in case of deviation of the movement of the injured upper limb from the normative route of movement, a multichannel asynchronous local transcutaneous muscle electrical stimulation by means of a system of electrodes in such a way that the actual route of movement of the injured upper limb corresponds to the route of movement established by the doctor in the form of a normative route adjusted for the recommended range of motion.

In addition, when calibrating the motion capture system, the patient is in a standing position.

In addition, when calibrating the motion capture system, the patient is in a sitting position.

In addition, at the stage of calibrating the motion capture system, the doctor additionally corrects the information about the recommended range of motion.

Comparative analysis of the features of the proposed solution with the features of the prototype and analogues indicates the compliance of the proposed solution with the criterion of "novelty".

At the same time, the distinctive features of the formula provide the solution of the following functional tasks.

Signs of "the patient is additionally equipped with a system of electrodes" provide the possibility of organizing biofeedback in the form of multichannel asynchronous local transcutaneous muscle electrical stimulation.

The signs “use a software package containing a normative route for performing movements described in the database of rehabilitation protocols” provide the possibility of using approved rehabilitation protocols and forming on their basis a basis for a comparative analysis of the movements of the injured upper limb.

The features “software complex… functionally combines a system of electrodes, equipment for reproducing content with elements of virtual reality, a motion capture system and an electronic computer for their control, as well as input and processing of information” ensure the joint and synchronous operation of various equipment.

The sign "the doctor enters information about the recommended range of motion into an electronic computer" implies an assessment of the patient's condition before the start of rehabilitation procedures and taking into account the individual characteristics of the patient when forming the route for performing the movement established by the doctor.

The features "the patient is equipped with equipment for playing content with elements of virtual reality, a motion capture system with sensors and an electrode system" describe the procedure for preparing the patient for rehabilitation procedures.

The signs “calibrate the motion capture system, in which the marker registers the position of the lower starting point of movement of the injured upper limb, which is also the origin of coordinates in the motion capture system” and the signs of dependent claims allow you to set the starting point of movement of the injured upper limb, synchronized with the system motion capture, relative to which organize the route of the movement.

The sign "the doctor selects a rehabilitation protocol from the database" allows you to select a rehabilitation protocol taking into account the individual characteristics of the patient.

Signs “during rehabilitation procedures, the patient, in parallel with the reproducible content with elements of virtual reality, performs movements of the injured upper limb according to the rehabilitation protocol when the motion capture system registers in real time the amplitude of movements in large joints, % of the angular deviation relative to the lower starting point of movement of the injured upper limb and duration performance of movements” describes the rehabilitation procedure and parameters automatically recorded during its execution, which characterize the actual route of movement execution by the injured upper limb.

Signs “biofeedback is organized starting from the second rehabilitation procedure, when, in case of deviation of the movement of the injured upper limb from the normative route of movement, multichannel asynchronous local transcutaneous muscle electrical stimulation is performed using an electrode system in such a way that the actual route of movement of the injured upper limb corresponds to the route of execution established by the doctor movements in the form of a normative route adjusted according to the recommended range of motions” allow you to automatically, in real time and taking into account the recommended range of motions, correct the movement of the injured upper limb based on a comparative analysis of the actual and normative routes of the movement.

In FIG. 1 shows the installation diagram of the electrode system:

a - front view of the patient;

b - back view of the patient.

In FIG. 2 shows a block diagram of the implementation of rehabilitation procedures.

In FIG. Fig. 3 conditionally shows the routes for performing movements, as an example, the abduction of the hand is taken.

The drawings show the patient data input unit 1, the manual calibration unit 2, the audiovisual content display unit 3 (hereinafter referred to as AVC) to the doctor, the automatic calibration unit 4, the AVC formation unit 5, the data processing unit 6, the biofeedback control unit 7 (hereinafter referred to as BOS), AVC transmission block 8, BOS data transmission block 9, data recording block 10, blocks for analyzing statistical 11 and dynamic 12 data, respectively, patient 13, electrodes located on the front of the right deltoid muscle 14, the back of the right deltoid muscle 15, anterior left deltoid 16, posterior left deltoid 17, left teres minor 18, right teres minor 19, left infraspinatus and subscapularis 20, right infraspinatus and subscapularis 21, anterior right triceps brachii 22, posterior right triceps brachii 23, anterior left triceps brachii 24, posterior left triceps brachii 25, anterior right biceps brachii 26, right biceps posterior 27, left biceps anterior 28, left biceps posterior 29.

Also, the drawings indicate the lower starting point of the movement 30 of the injured upper limb, the normative 31 established by the doctor 32 and the actual 33 routes of the movement, the comparison 34 of the actual 33 and the normative 31 routes of the movement, the deviation 35 of the actual 33 and the routes of the movement 32 established by the doctor.

An electronic computer includes three nodes, consisting of the following blocks:

- doctor's node - contains block 1 for entering patient data, block 2 for manual calibration and block 3 for displaying audiovisual content (hereinafter referred to as AVC) to the doctor;

- AVK and BOS control unit - contains automatic calibration unit 4, AVK formation unit 5, data processing unit 6, BOS control unit 7;

- node data analysis - contains blocks of analysis of statistical 11 and dynamic 12 data.

The patient interaction node includes the following blocks:

- AVK transmission unit 8 - placed in equipment for playing content with elements of virtual reality, which can be made in the form of glasses, a helmet, etc. devices;

- BOS data transmission unit 9 is implemented in the form of a system of electrodes 14-29, with the help of which multichannel asynchronous local transcutaneous muscle electrical stimulation is carried out;

- data recording unit 10 - implemented as a motion capture system (preferably wireless) with sensors.

The inventive method is carried out on standard equipment in several stages.

1. Selection of patients and determination of their baseline characteristics.

To ensure safety, patients are selected who meet the following criteria:

Patient Inclusion Criteria:

- age from 18 to 60 years at the time of the study;

- the period from the moment of the stroke from 3 months to 1.5 years;

- availability of signed informed consent;

- the level of muscle tone is not more than 3 points on the Ashworth scale;

- Rankin mobility index no more than 3 points;

- the absence of gross cognitive impairment.

Criteria for non-inclusion of patients:

- pregnancy at the time of the study according to anamnesis;

- acute cardiovascular or pulmonary disease, which is a contraindication to active rehabilitation;

- migraine and cluster headache in history;

- clinically diagnosed seizures in history (with the exception of febrile seizures and seizures caused by electroshock therapy);

- abuse of drugs that are under special control, requiring formal treatment;

- use of medications that can lower the seizure threshold (including but not limited to tricyclic antidepressants and antipsychotic agents);

- known skin allergy to adhesives;

- mental illness, including due to alcohol or drug abuse;

- conditions that, in the opinion of the doctor and the researcher, may affect the outcome of treatment (active neoplastic process, immunodeficiency, tuberculosis, etc.);

- the presence of an artificial pacemaker;

- other acute contraindications identified based on the assessment of the study team.

Criteria for exclusion of patients from the rehabilitation procedure (i.e. grounds for terminating the application of the method):

- refusal of the patient to participate in any of the stages of treatment;

- complications associated with therapy, leading to a violation of the regimen and terms of treatment, or undesirable adverse reactions that cannot be corrected.

Prior to the start of rehabilitation procedures, the patient passes the following scales: Pain detect, Ashworth, HADS, PHQ-9, MMSE / MoCA test, Barthel ADL index, Fugl-meyer.

2. Introduction by the doctor of information about the patient and the recommended range of motion into an electronic computer.

The rehabilitation doctor enters the patient's personalized data into the patient data input block 1, namely the patient's identification data (height, weight, etc.).

Next, the rehabilitation doctor, using manual calibration block 2, performs personalized adjustment of the AVK, namely, he enters data on the condition of the patient 13 in accordance with the results of passing the scales obtained at the previous stage, which is reflected in the change in the recommended range of motion in various planes, angles, order and list of rehabilitation exercises.

3. Preparation of the patient for rehabilitation procedures.

Under the supervision of a rehabilitation physician, the patient 13 puts on the AVK transmission unit 8, the BOS data transmission unit 9 in the form of a system of electrodes 14-29 placed in places of thickening of the affected muscles of the patient's upper limbs 13 and the data recording unit 10, which is a motion capture system.

4. Calibration of the motion capture system.

The patient 13, who is in a standing or sitting position, is given a marker in the injured hand, and using the data recording unit 10, the automatic calibration unit 4, which receives data about the patient through the manual calibration unit 2, performs automatic personalized calibration of the position of the patient 13 in the AVC, and namely, a new coordinate axis is created in such a way that its origin coincides with the lower starting point of movement 30 of the injured upper limb and the origin of coordinates in the motion capture system.

5. Selection by the doctor of the rehabilitation protocol from the database.

At this stage, the rehabilitation doctor enters data into manual calibration block 2 and selects exercises for the left and right hands to be included in the rehabilitation program and create a personalized patient rehabilitation protocol from the following list:

1) pull towards you;

2) push away from you;

3) pull from bottom to top;

4) extension of the shoulder joint.

The protocol of each individual exercise selected by the rehabilitation doctor in block 2 of manual calibration contains:

- ten repetitions of the exercise independently by the patient, without activation of the system of electrodes 14-29, during which the current state of the biomechanics of the joints and the patient's muscle activity are determined; the duration of the exercises is 20 minutes.

- ten repetitions of the exercise by the patient with active electrodes 14-29, during which the synchronized blocks of data processing 6, BOS control 7, data recording 10 monitor the quality of the exercises and the volume of movements, adjusting them in accordance with the criteria and area of the movement trajectory established by the doctor; rehabilitation specialist in the manual calibration unit; the duration of the exercises is 20 minutes.

The general course of rehabilitation procedures is 10-12 days.

6. Carrying out rehabilitation procedures (and organizing biofeedback).

After personalized calibration of the position of the patient 13 in the AVC and the selection of a rehabilitation protocol from the automatic calibration unit 4, the data are sequentially fed to the data processing unit 6 and the AVC generation unit 5 to output the AVC to the patient 13 through the AVC transmission unit 8.

Audiovisual content is a relaxing space aimed at the implementation of sensory deprivation in order to concentrate the patient on the rehabilitation procedure, in turn, audiovisual content, made on the example of virtual reality, allows patients to immediately see the results of their efforts, which has a pronounced beneficial effect on motor rehabilitation and motivates stroke survivor to work.

The patient, in parallel with the AVC, reproduced using the AVC transmission unit 8, performs movements of the injured upper limb according to the rehabilitation protocol selected at the fifth stage, when the unit 10 registers in the form of a motion capture system in real time the amplitude of movements in large joints (shoulder, elbow, wrist), % of angular deviation relative to the lower starting point of movement 30 of the injured upper limb and the duration of the movements.

Block 5 of the formation of the AVC is connected with the block 7 of the BOS control, which controls the system of electrodes 14-29 in the block 9 of the data transmission of the BOS during the implementation of rehabilitation procedures, due to which biofeedback is organized.

When the movement 34 of the injured upper limb deviates 34 from the normative route 31 of performing the movement, the corresponding data is received from the patient 13 through the data recording unit 10 (in the form of a motion capture system) to the BFB data transmission unit 9, which is used to carry out multichannel asynchronous local transcutaneous muscle electrical stimulation by means of electrode systems 14-29 in such a way that the actual route 33 of movement of the injured upper limb corresponds to the route of movement set by the doctor 32 in the form of a normative route 31 adjusted for the recommended range of motion.

The organization of biofeedback starting from the second rehabilitation procedure allows creating a basis for comparative analysis and objectively assessing the results of rehabilitation procedures.

The data recording unit 10 sends data to the statistical 11 and dynamic 12 data analysis units, which receive, process and transmit standardized information on the implementation of rehabilitation to the VKA display unit 3 for the doctor, designed to control the entire rehabilitation process by the rehabilitation doctor.

In the process of performing rehabilitation procedures, the block 11 for analyzing statistical data conducts an automatic personalized analysis of the patient's condition in order to generate a report on the quality and progress of a single implementation of the established procedure and highlights the following criteria for assessing rehabilitation:

1) the number of deviations 35 of the actual route 33 of the movement of the injured upper limb from the route established by the rehabilitation doctor 32, units. rev. - quantity;

2) the magnitude of the deviation 35 of the actual route 33 of the movement of the injured upper limb from the route established by the rehabilitation doctor 32, units. rev. - meter;

3) the duration of one exercise by the patient, units. rev. - sec.;

4) the proportion of the volume of movements performed by the patient during the exercise, from the route established by the rehabilitation doctor, units. rev. -%.

In the process of performing rehabilitation procedures, the block 12 for analyzing dynamic data conducts an automatic personalized analysis of the patient's condition throughout all past procedures in order to generate a report on the quality and full course of rehabilitation and highlights the following criteria for assessing rehabilitation:

1) the average number of deviations 35 of the actual route 33 of the movement of the injured upper limb from the route established by the rehabilitation doctor 32, based on the results of completing the full course of procedures, units. rev. - quantity;

2) the average deviation distance 35 of the actual route 33 of the movement of the injured upper limb from the route established by the rehabilitation doctor 32, based on the results of completing the full course of procedures, units. rev. - meter;

3) the average duration of one exercise by the patient, based on the results of the full course of procedures, units. rev. - sec.;

4) the proportion of the average volume of movements performed by the patient during the exercise, from that established by the rehabilitation doctor based on the results of completing the full course of procedures, units. rev. -%.

The proposed method is illustrated by the following clinical examples.

Clinical example 1.

Patient S., a woman born in 1982, was treated in a day hospital at the outpatient clinic of the Center for Restorative Medicine and Rehabilitation of the FEFU Medical Center from 05/14/2021 to 06/05/2021 with a diagnosis: (I 69.3) the consequences of acute cerebrovascular accident in the pool left middle cerebral artery according to the hemorheological type from 07/21/2020. Moderate right-sided hemiparesis. Sensorimotor aphasia. Multiple aneurysms of the cerebral arteries. Saccular aneurysm of the bifurcation of the right middle cerebral artery. Operative treatment on 04.12.2015: osteoplastic frontotemporal trepanation on the right, microsurgical clipping of the saccular aneurysm of the bifurcation of the right middle cerebral artery. Miliary saccular aneurysm of the bifurcation of the left middle cerebral artery. Surgery on July 15, 2020: resource-intensive endovascular intervention: thrombosis of a saccular trifurcation aneurysm of the left middle cerebral artery using a flow stent FRED Jr.

Complication: stent thrombosis of the flow stent. Operation 07/21/2020: extraction of the FRED Jr. flow stent. from the left middle cerebral artery. (I63.8) (S36.8) Postoperative retroperitoneal hematoma.

On admission: right-sided hemiparesis to plegia in the hand. In the proximal sections 3 b, distal 0 b. muscle tone in the arm 4 b, flexion contracture in the elbow and wrist joint. Frenchay 0 b. Does not use his hand independently, raises it only with the help of the second hand.

She received a complex of treatment: exercise therapy, speech therapy, mechanotherapy, rehabilitation using biofeedback and elements of virtual reality.

At the end of the course of treatment: there is an increase in the volume of active movements in the leg and the appearance of active movements in the arm and hand. Frenchay 2 b. The function of balance and equilibrium has improved, he walks independently without support, there is a positive dynamics of speech, and tolerance to physical exertion has increased. Rankin 2. Restriction of active movements in the right hand, increased muscle tone in the arm 3 b, leg 2 b, violation of the supporting function of the foot, speech disorders.

The patient can take care of herself independently, has adapted to use her hand for pushing, holding objects, can straighten her hair on her head.

Clinical example 2.

Patient Ya., a man born in 1968, was treated in a day hospital at the polyclinic of the Center for Restorative Medicine and Rehabilitation of the FEFU Medical Center from 01/28/2021 to 02/12/2021 with a diagnosis of (I 69.3) consequences of acute cerebrovascular accident due to ischemic type dated 01/17/21 in the basin of the right MCA, early recovery period left-sided hemiparesis to plegia in the arm.

Hypertension 3 tbsp., Risk 4. Dyslipidemia. Abdominal-constitutional obesity 3 tbsp. Chronic cholecystitis. ICD.

On admission: the patient is a captain by profession. Request for rehabilitation - independently hold the helm. Plegia in the left hand. There are no active movements in the distal sections. In the proximal - abduction and flexion in the shoulder joint by 20 °. Muscle tone is increased in the hand up to 1 p. Cannot put on outerwear without help.

He received a complex of treatment: exercise therapy, passive mechanotherapy with biofeedback, mirror therapy, rehabilitation using biofeedback and elements of virtual reality.

At the end of the course of treatment: against the background of the measures taken, he notes an increase in the volume of active movements in the left limbs, the function of balance and balance has significantly improved, he walks independently without support, the support function of the left leg has improved, tolerance to physical activity has increased, the emotional background has improved, pain in the shoulder has decreased joint VAS 2 b. There were active movements in the hand, global movements are possible - the capture of large objects due to an increase in movements in the shoulder joint and elbow. Serves itself completely independently. Frenchay 4 b. Rankin 2. There is a violation of fine movements in the hand, paresis of the foot.

Clinical example 3.

Patient A, a man born in 2004, was treated in a day hospital at the outpatient clinic of the Center for Restorative Medicine and Rehabilitation of the FEFU Medical Center from 02/03/2020 to 02/18/2020 with a diagnosis of (I63.3) consequences of ischemic stroke in the ACA pool, SMA on the right of 01/03/2020 with the formation of an infarction focus in the temporal-fronto-parietal region, with spread to the basal nuclei. Unspecified subtype. early recovery period. Left-sided hemiparesis, to plegia in the arm. Left-sided prosoparesis.

On admission: left-sided hemiparesis. In the leg, the strength is 3 b, in the arm 2 b in the proximal section, 0 b in the hand. Muscle tone in the muscles of the leg according to Ashfort 1 b, in the hand 2 b.

The amplitude of active movements in the shoulder joint: pronounced limitation: flexion (adduction of crying forward - 20 °; extension (abduction back) - 0 °; abduction of the shoulder to the side - 10 °. The amplitude of active movements in the elbow joint: significantly pronounced: flexion - 90 °, extension - 140°.

He received a complex of treatment: exercise therapy, passive bicycle ergometry, rehabilitation using biofeedback and elements of virtual reality.

At the end of the course of treatment: left-sided hemiparesis. In the leg, the strength is 5 b, in the arm 3 b in the proximal section, 0 b in the hand. Muscle tone in the muscles of the leg according to Ashfort 1 b, in the hand 1 b.

Range of active movements in the shoulder joint: significant limitation: flexion (abduction of the shoulder forward - 75°; extension (abduction back) - 5°; abduction of the shoulder to the side - 50°. Range of active movements in the elbow joint: moderately pronounced: flexion - 40 °, extension - 150 ° Active movements in the wrist joint and hand are absent.

Repetition of rehabilitation procedures after 1.5 months: exercise therapy, rehabilitation using biofeedback and elements of virtual reality. The course consisted of 10 procedures.

Left-sided hemiparesis. In the leg, the strength is 5 b, in the arm 4 b in the proximal section, 1 b in the hand. Muscle tone in the muscles of the leg according to Ashfort 1 b, in the hand 1 b.

Range of active movements in the shoulder joint: flexion (abduction of the shoulder forward - 160°; extension (abduction back) - 15°; abduction of the shoulder to the side - 150°. Range of active movements in the elbow joint: flexion - 110°; extension - full. Active movements in the wrist joint: flexion - 55°, extension - 5°.

Claims (4)

1. A method for the rehabilitation of the upper limbs of stroke patients using biofeedback and elements of virtual reality, in which the patient is equipped with equipment for playing content with elements of virtual reality and a motion capture system with sensors, downloading a software package containing elements for generating content with elements virtual reality and controls, then the patient, in parallel with the reproduced content with elements of virtual reality, performs movements with the damaged part of the body while registering the amplitude of movements and the duration of their implementation and organizing biofeedback, characterized in that the patient is additionally equipped with a system of electrodes, using a software package containing normative route for performing movements described in the database of rehabilitation protocols and functionally combining a system of electrodes, equipment for playing content with virtual elements motion capture system and an electronic computer for their control, as well as input and processing of information, moreover, the doctor enters information about the recommended range of movements into the electronic computer, after which the patient is equipped with equipment for playing content with elements of virtual reality, a motion capture system with sensors and a system of electrodes, then the motion capture system is calibrated, in which the position of the lower starting point of movement of the injured upper limb is recorded using a marker, which is also the origin of coordinates in the motion capture system, the doctor selects a rehabilitation protocol from the database and during rehabilitation procedures the patient in parallel with the reproduced content with elements of virtual reality, performs movements of the injured upper limb according to the rehabilitation protocol when the motion capture system registers in real time the amplitude of movements in large joints tavakh, % of angular deviation relative to the lower starting point of the movement of the injured upper limb and the duration of the movements, while biofeedback is organized starting from the second rehabilitation procedure, when in case of deviation of the movement of the injured upper limb from the normative route of the movement, multichannel asynchronous local transcutaneous muscle electrical stimulation is performed by means of a system of electrodes in such a way that the actual route of movement of the injured upper limb corresponds to the route of movement established by the doctor in the form of a standard route adjusted for the recommended range of motion. 2. The method of rehabilitation according to claim 1, characterized in that when calibrating the motion capture system, the patient is in a standing position. 3. The method of rehabilitation according to claim 1, characterized in that the patient is in a sitting position during the calibration of the motion capture system. 4. The method of rehabilitation according to claim 1, characterized in that at the stage of calibrating the motion capture system, the doctor additionally corrects information about the recommended range of motion.

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