Post-stroke synkinesis: clinical and rehabilitation aspects. a review

摘要

INTRODUCTION. Involuntary associated movements (synkinesis) are a common occurrence in post-stroke patients. In Russia, the Marie-Foy classification subdivides these movements into global, imitative, and coordinator types. In the English-language literature, they are referred to as “motor irradiation,” “motor overflow,” “mirror movements,” “abnormal communication,” and others. Despite attempts to utilize synkinesis as a means of restoring function in paretic limbs, their rehabilitative value is still insufficiently investigated. AIM. Based on literature data, to study the features of pathological synkinesis in post-stroke patients, and to evaluate the possibility of their use to optimize rehabilitation methods (kinesitherapy). MATERIALS AND METHODS. The bibliographic search was carried out in PubMed, Web of Science, and Scopus databases. The following keywords were used: global synkinesis, mirror synkinesis, motor irradiation, abnormal coactivation, PNF, rehabilitation. The review focused on English-language controlled randomized trials and reviews over the past 20 years. A total of 152 sources were reviewed, 77 of which met predefined criteria and were selected for the narrative review. RESULTS AND DISCUSSION. The analysis of the literature indicates that basic traditional classification of post-stroke Marie-Foy synkinesis should be preserved, but this requires some additions. The following types of post-stroke synkinesis should be considered: global, respiratory-brachial, imitation, coordinator and anomalous. In addition to kinesiotherapy via proprioceptive neuromuscular facilitation, these techniques can be employed in conjunction with various other methods, including functional electrical stimulation, bilateral training, mirror therapy, Taub restrictive therapy, and others. Coordinating and abnormal synkinesis have the greatest rehabilitation value. In the residual period of a stroke, persistent abnormal synkinesis may limit voluntary motor skills and requires inactivation. In this case, orthopaedic fixation, reflex-suppressive positions, Perfetti therapy, biofeedback and virtual reality robotic simulators are recommended. CONCLUSION. The traditional Marie-Foy classification of post-stroke motor synkinesis has no alternatives but needs to be supplemented. It is advisable to distinguish the following types of synkinesis: global, respiratory-brachial, imitation, coordinator and anomalous global, respiratory-brachial, imitation, coordinator and anomalous. The most valuable material for kinesitherapy techniques is coordination and anomalous synkinesis. In the residual period of stroke, the remaining abnormal synkinesis limits voluntary motor activity and requires inactivation.