The technology of objective assessment of motor disorders in the dynamics of rehabilitation in patients with traumatic and orthopedic profile

Authors:

Koroleva Svetlana Valeryevna — Doctor of Medical Sciences, Professor of the Department of Traumatology and Orthopedics Federal State Budgetary Educational Institution of Higher Education “Ivanovo State Medical Academy” of the Ministry of Healthcare of the Russian Federation (FSBEI HE IvSMA MOH Russia), 8, Sheremetyevo Avenue, Ivanovo region, Ivanovo, 153012, Russian Federation; Associate Professor at the Department of Extreme and Military Medicine, 9, Demidova str., Ivanovo, 153002, Russian Federation, tel.: +79203775271, e-mail: drqueen@mail.ru

Annotation:

Introduction. The demand and growth in the number of new technologies for the treatment of patients with traumatological and orthopedic profile, the expansion of indications for surgical interventions associated with an increase in their safety, the expediency of multidisciplinary management of such patients — all this actualized the improvement of technologies for objective evaluation of the results of the dynamics of movement recovery. The systems for clinical assessment of the effectiveness of rehabilitation do not fully reflect the recovery process, and the most objective is the assessment of biomechanical parameters of movement, including the walking pattern.

The aim of the study is to develop a technology for an objective assessment of movement disorders in the early rehabilitation period after total arthroplasty of large joints based on inertial sensors.

Materials and methods. The study involved 54 patients in the dynamics of knee arthroplasty, 47 — in the dynamics of hip arthroplasty. The study of walking function was carried out three times — upon admission, one week later, and two weeks after the end of the course. Registration of gait parameters was carried out using a gait trainer with biofeedback Stadys of the Neurosoft LLC (Ivanovo) in the Appraisal package (RC No. RZN 2018/7458 of 07.08.2018). The results were processed by standard methods of biomedical statistics at a 5 % significance level. Factor analysis was performed on the SPSS Statistica 23.0 platform.

Results and discussion. In the period of early rehabilitation, walking of patients after endoprosthetics of large joints of the lower extremities is characterized by a decrease in the speed of movement, compensatory unloading and asymmetry of indicators of the function of the lower extremities. In the dynamics of rehabilitation, the asymmetry decreases, more in the group of patients after knee arthroplasty. It was found that within 6 months after hip arthroplasty and 4 months after knee arthroplasty, complete restoration of the walking pattern does not occur. Factor analysis made it possible to determine that the phase and temporal parameters of walking are fundamental (reference). The biofeedback method opens up the possibility of active participation of the patient in rehabilitation programs. Improvement of rehabilitation programs for patients with traumatological and orthopedic profile is more effective when using programs for objective analysis of the function of movement.

Conclusion. Objective assessment of biokinematics in dynamics endoprosthetics of large joints allows identifying markers for the immediate and separate perspectives of functional rehabilitation. The main goal of medical rehabilitation is to reduce/eliminate asymmetry when walking, in the long term is to restore normal stride length.

List of cited literature:

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