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Publication date: 15.09.2025
DOI: 10.24412/2782-6570-2025_04_03_4
UDC 376.2
IMPROVING PSYCHOFUNCTIONAL STATE AND QUALITY OF LIFE WITH PHYSICAL REHABILITATION AFTER TRAUMATIC BRAIN INJURY COMBINED WITH SPASTIC HEMIPARESIS
E.V. Bogomolova1, N.V. Lunina1,2
1Russian University of Sports “GTSOLIFK”, Moscow, Russia
2North-Caucasian Federal Research-Clinical Center of Federal Medical and Biological Agency, Essentuki, Russia
Abstract. Introduction. The article presents a study on increasing the activity of life, self-care skills and psychofunctional state in men with traumatic brain injury combined with spastic hemiparesis by physical rehabilitation means. Methods. The study involved seven men with traumatic brain injury, age – 25-35 years. Activities of daily living and self-care skills were estimated with the Barthel index and the modified Rivermead mobility index. Severity of pain syndrome was assessed with the visual analogue scale, functional state of the musculoskeletal system – with the Ashworth scale and Motricity index. Results. The positive effect is represented by reliable improvements in the Barthel, Rivermead and Motricity indices, in the results of the Ashworth scale, the visual analogue scale, the Berg balance scale, the Wakefield questionnaire, the Standing balance test and the Functional categories of walking test. Conclusion. The physical rehabilitation course after traumatic brain injury combined with spastic hemiparesis has significantly improved activities of daily living and supported the recovery of self-care skills and psychofunctional state.
Keywords: traumatic brain injury, spastic hemiparesis, activities of daily living, self-care, psychofunctional state, physical rehabilitation, motor activity.
Introduction. Modern data show that brain injuries are one of the main causes of disability and mortality of the population [1]. Each year, 1.5 million die from traumatic brain injury (TBI), 2.4 million become disabled. The incidence of TBI is 3-4 per 1000 population on average [1, 2]. In Russia, the leading causes of TBI are home accidents, car incidents and military injuries. In terms of gender, there are 2.5 times more men than women, who suffer from TBI [2]. According to the data from the Sklifosovsky Institute for Emergency Medicine, the number of hospitalized patients with TBI in Moscow is 10 000 to 13 000 per year, average age – up to 43 years [3]. Frequently, the received brain injury is complicated by changes in muscle tone and worsened mental state, which limit rehabilitation potential of the patients [4].
The importance of physical rehabilitation after TBI is due to a necessity to restore the functions lost after the injury: limb mobility, movement coordination, self-care skills, walking and other social skills [4, 5], in some cases professional skills as well, which demonstrates the relevance and timeliness of this research. Moreover, success of rehabilitation is significantly regulated by terms and volume of those rehabilitation measures that take into account clinical signs and rehabilitation potential of the patients.
Objective of the study: to estimate changes in activities of daily living, self-care skills and psychofunctional state of men with TBI combined with spastic hemiparesis after the physical rehabilitation course.
Methods and organization. The study included men with TBI (n=7). The inclusion criteria: gender – male; age – 25-35 years; diagnosis – TBI; severity – moderate (according to the L.B. Likhterman); motor disorders – spastic hemiparesis; recovery period – interim; voluntary consent to participate in the study.
Activities of daily living and self-care skills were estimated with the Barthel index (points) and the modified Rivermead mobility index (mRMI-ICU, points). Severity of pain syndrome was assessed with the visual analogue scale (VAS, points). Functional state of the musculoskeletal system was estimated with the modified Ashworth spasticity scale (points) and the Motricity index (motor tests for higher and lower limbs, points). Balance was assessed with the standing balance test (points) and the Berg balance scale (points), motor behavior – with the Functional categories of walking test (level), psychophysiological state – with the Wakefield questionnaire (points).
The results were processed in the Statistica 13 software package. We calculated the mean (M) and the standard deviation (σ). The distribution normality was estimated with the Shapiro-Wilk test, reliability of differences in the studied indices before and after physical rehabilitation was identified with the Wilcoxon’s signed-rank test, p≤0.05.
Physical rehabilitation measures were applied in a course that lasted 12 weeks. The following measures and forms were used: morning hygienic gymnastics (MHG) with calisthenic routine (CR), static and dynamic breathing (BE) exercises (everyday, 7-10 minutes in the initial position of lying on the back); therapeutic gymnastics (5 times a week, 20 minutes), including: CR (for all muscles of healthy limbs), BE (static and dynamic), special exercises (SE): passive, active-passive exercises for injured limbs, exercises for the back, pelvic and abdominal muscles, isometric contraction in the muscles of the injured limbs, stretching exercises, exercises for the vestibular system, verticalization therapy for a patient while sitting, then standing, verticalization training while sitting, balance exercises while sitting. The exercises were performed in the initial position of lying on the back, lying on the side and sitting. The active-passive exercises were carried out with the help of an instructor. Then, classes were held not only in the ward, but also in the physical therapy cabinet in the initial position of lying on the back, lying on the stomach, sitting, standing, standing at the wall bars in a knee pad. We included balance exercises in the sitting and standing positions, trained support for the injured limbs, taught walking recovery skills, followed by its training with the help of the instructor. To relax the spastic muscles, positioning (laying) was used (2-3 times a day for 20 minutes) and paraffin applications to the injured limbs (10 procedures every other day, 15-20 minutes each) in alternation with magnet therapy (10 procedures, 15 minutes each). Mechanotherapy was applied (the Motomed training device, Imitron): passive, active-passive movements of the legs and arms (daily, for 20 minutes). Therapeutic massage (10 procedures, 5 days a week, 15-20 minutes each) was implemented in alternation with acupuncture (10 procedures, 20 minutes each). Later, we included independent classes (active, active-passive exercises) aimed at restoring walking and household skills. As the walking skills with auxiliary equipment (walker, cane) were mastered, walking was prescribed daily with a gradual increase in time to 20 minutes. To train the correct walking pattern, treadmill exercises were also included (every other day, for 20 minutes, at a slow pace).
Results and discussion. After the physical rehabilitation course for patients with TBI combined with spastic hemiparesis, we have discovered an improvement in activities of daily living and level of independence in everyday life estimated by the Barthel index. At the beginning of the course, the Barthel index scored 6.86±2.98 points, showing dependence on external support in everyday life. At the end of the course, the index has increased by 75%, reaching 12±2.57 points and showing moderate degree of dependence on external support. The mobility level (the Rivermead mobility index, mRMI-ICU) has increased by 124% from moderate (3±0.86 points) to mild (6.71±0.49 points) degree.
We have also revealed reduced pain syndrome (VAS): in the higher limb – by 48% from moderate (3.29±1.18 points) to mild (2.14±1.84 points) degree; in the lower limb – by 47%, from 2.14±1.84 points to 1.14±1.02 points. According to the Ashworth’s scale, the muscle spasticity of the higher (by 40%, from 2.14±0.24 to 1.29±0.41 points) and lower limbs (by 42%, from 1.71±0.41 to 1.00±0.29 points) has also reduced.
In terms of the most motor functions estimated by the Motricity index, movements in joints and muscle strength in the injured limbs have reliably improved (p<0.05): pinch-grasp – by 81%; elbow flexion – by 70%; shoulder abduction – 47%; ankle dorsiflexion – by 75%; knee extension – by 47%; hip flexion – by 34% (table).
Table
Changes in the Motricity index before and after the physical rehabilitation course after traumatic brain injury combined with spastic hemiparesis, M±σ, points
|
Indices |
Before |
After |
P< |
|
Pinch-grasp |
10.57±6.04 |
19.14±4.73 |
0.05 |
|
Elbow flexion |
12.71±4.69 |
21.57±2.94 |
0.05 |
|
Shoulder abduction |
10.57±3.92 |
15.57±2.69 |
– |
|
Ankle dorsiflexion |
8.43±2.41 |
14.71±2.45 |
0.05 |
|
Knee extension |
12.57±3.06 |
18.43±2.53 |
0.05 |
|
Hip flexion |
15.43±3.06 |
20.71±2.45 |
0.05 |
Balance function have also significantly improved: in the Berg balance scale – from 2.29±0.41 to 3.57±0.49 points; in the standing balance test – from 0.43±0.61 to 2.57±0.65 points. In the Functional categories of walking test, the results increased from 0.71±1.02 to 3.57±0.77 points.
Recovery and improvement of the lost motor functions due to the injury have positively influenced psychoemotional state of the patients after the physical rehabilitation course. The initial score of the Wakefield questionnaire indicated its presence (19±2.57 points), then it has reduced to 11.43±2.78 points showing no signs of depression among the patients.
Conclusion. The physical rehabilitation course after traumatic brain injury combined with spastic hemiparesis has significantly improved activities of daily living and supported the recovery of self-care skills and psychofunctional state. The positive effect is represented by the reliable improvements of the Barthel, Rivermead and Motricity index, in scores of the Ashworth scale, VAS, the Berg balance scale and the Wakefield questionnaire, in the results of the standing balance test and the Functional categories of walking test.
Conflict of interest. The authors declare no conflict of interest.
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INFORMATION ABOUT THE AUTHORS:
Evgenia V. Bogomolova – Magister of the Department of Physical Rehabilitation, Massage and Health-improving Physical Culture named after I.M. Sarkizov-Serazini, Russian University of Sports “GTSOLIFK”, Moscow.
Natalya V. Lunina – Candidate of Biological Sciences, Associate Professor of the Department of Physical Rehabilitation, Massage and Health-improving Physical Culture named after I.M. Sarkizov-Serazini, Russian University of Sports “GTSOLIFK”, Moscow; Senior Researcher, North-Caucasian Federal Research-Clinical Center of Federal Medical and Biological Agency, Essentuki, e-mail:
For citation: Bogomolova E.V., Lunina N.V. Improving psychofunctional state and quality of life with physical rehabilitation after traumatic brain injury combined with spastic hemiparesis. Russian Journal of Sports Science: Medicine, Physiology, Training, 2025, vol. 4, no. 3(15). DOI: 10.24412/2782-6570-2025_04_03_4