Relationship between Movement Stereotype and Focus Location in the Early Recovery Period after Mild Ischemic Stroke

Objectives. To study the characteristics of the movement stereotype in the early recovery period of ischemic stroke in the basin of the internal carotid artery and the vertebrobasilar system. Materials and methods. Eleven patients (five men, six women, mean age 57.2 ± 5.2 years) were studied 4–6 weeks after ischemic stroke. Initial scores on the NIHSS averaged 6.2 ± 0.8, with 3.9 ± 0.7/3.7 ± 0.8 points for arm/hand paresis and 4.3 ± 0.6/4.0 ± 0.5 points for leg/foot paresis. Foci were located in the basin of the internal carotid artery in seven patients and in the vertebrobasilar system in four. Investigations were run on admission and after 2–2.5 weeks. Changes on the FIM and Ashworth spasticity scales, a hand dexterity test (nine hole peg test, NHPT), and the Timed Up and Go test (TUG) were evaluated, along with changes on the Berg balance test and the 20-point vertigo scale, the MMSE, and the Beck and Spielberger questionnaires. Video analysis of movements was carried out using a Physiomed Smart system (Physiomed, Germany) using the Davis protocol. Results. On the background of rehabilitation measures, all patients showed decreases in the severity of paresis, improvements on the FIM, Ashworth, and Berg scales and on the NHPT and TUG tests. Patients with foci in the vertebrobasilar system, in contrast to those with foci in the basin of the internal carotid artery, had impairments to balance detected on the 20-point vertigo scale. On video analysis, all patients showed changes in the movement stereotype in the form of shortening of the length and increases in the width of the gait, with decreases in speed and lengthening of the stepping cycle; these changes were more marked for foci in the vertebrobasilar system. A distinguishing feature for foci located in the vertebrobasilar system was forward tilting of the pelvis, while lateral tilting of the pelvis was seen with foci located in the basin of the internal carotid artery. Conclusions. Focus location in mild ischemic stroke can affect the features of recovery and movement stereotypy, and this should be considered in rehabilitating these patients.