Реабилитация пациентов в отдаленном периоде травмы спинного мозга: метаанализ литературных данных

Abstract

Material\xa0 and Methods . The\xa0 study design is a meta-analysis of publications with levels\xa0 1a, b, c, and\xa0 2a evidence and\xa0 a level A recommendations. An electronic search was conducted in the\xa0 PubMed, Web of Science, Scopus, Cochrane Library, CrossRef, AO Spine, Eurospine, ResearchGate, eLIBRARY, and MEDLINE databases, and in references of key articles. Inclusion criteria were systematic reviews, randomized controlled studies, multicenter cohort studies with a level 1a, b, c, and 2a evidence and level A recommendations for adult patients with long-term sequelae of spinal cord\xa0 injury (more than 4 months after injury). Exclusion criteria were\xa0 topic articles, clinical\xa0 cases, observations, cohort uncontrolled studies, experimental articles, reports, articles with levels 2b, c, 3a, b, 4, and 5 evidence and level B, C, and D recommendations, pediatric patients, early period after spinal cord injury (less than 4 months), and non-traumatic lesions of the spinal cord. Results . The\xa0 search returned 108 articles with publication date within 1997–2019. The\xa0 inclusion criteria was\xa0 met\xa0 by 65 publications: 33 systematic reviews, 12 randomized controlled studies, 19 multicenter studies; and one open\xa0 prospective study was included in the\xa0 review due\xa0 to the\xa0 particular treatment method used. The\xa0 greatest evidence base\xa0 for the\xa0 rehabilitation of patients in the\xa0 long-term period after spinal cord\xa0 injury is presented for physical methods of rehabilitation. The\xa0 most effective are locomotor training to develop skills\xa0 of movement. Auxiliary verticalization and robotic devices are needed to restore and improve proprioceptive innervation. In case of violation of the\xa0 spinal tracts, the\xa0 restoration of motor functions occurs due\xa0 to the\xa0 activation of supraspinal interneuronal connections. Epidural electrical stimulation of the\xa0 lumbar thickening of the\xa0 spinal cord\xa0 activates a generator of voluntary movement of the\xa0 limbs\xa0 and,\xa0 in combination with training of proprioceptive sensitivity, leads to a regression of movement disorders. The\xa0 constant use\xa0 of electrostimulation blocks proprioceptive sensitivity and inhibits the\xa0 recovery of spinal conductivity. Parameters of clinical\xa0 application are not\xa0 defined for areas of regenerative medicine. Conclusion . The\xa0 main problem in rehabilitation of patients in late\xa0 period after spinal cord injury is the lack of a unified concept, developed strategies of rehabilitation technologies, and criteria for assessment of the\xa0 initial status and treatment efficiency.