Motor Overflow in Post-stroke Patients and their Rehabilitation Significance. A Review.
Authors:   Novokuznetsk State Institute for Further Training of Physicians – Branch Campus of the Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia, Petrov K.B. , Mitichkina T.V. ,   Novokuznetsk State Institute for Further Training of Physicians – Branch Campus of the Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia
Published: October 2024

INTRODUCTION. Post-stroke patients often develop involuntary concomitant movements (synkinesis), which are closely related to the state of muscle tone and the nature of tendon reflexes on the side of hemiparesis. In Russia, according to the Marie-Foix classification, synkinesis is usually divided into global, imitation and coordination, and in the English-language literature terms such as “motor irradiation”, “motor overflow”, “mirror movements”, “abnormal coactivation” are used to designate them. etc. There are attempts to use these conjugal movements to restore the function of paretic limbs, but their rehabilitation value has not been sufficiently studied. 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). MATERIAL AND METHODS. The bibliographic search was performed in the scientific citation databases RSCI, PubMed, Web of Science and Scopus. The following keywords were used: "global synkinesis", "imitation synkinesis", "coordinator synkinesis", "mirror synkinesis", "motor irradiation", "abnormal coactivation", "PNF", "rehabilitation". The initial search for sources within the last 5 years did not reveal enough of them to compile a full-fledged review, for this reason, the analysis era was extended to 20 years. The main attention is paid to English-language controlled randomized trials and reviews. A total of 152 sources were analyzed, 72 of which met the specified criteria and were selected for compiling this analytical review. RESULTS AND DISCUSSION. The conducted literature analysis convinces that the basis of the traditional classification of post-stroke synkinesis by Marie-Foix should be preserved, but some additions are needed. The following types of post-stroke synkinesis should be taken into account: global, respiratory-brachial, imitative, coordinative and abnormal. In addition to kinesitherapy using proprioceptive neuromuscular facilitation, they can be used in the methods of functional electrical stimulation, bilateral training, mirror therapy, restrictive therapy according to Taub, etc. Coordinative and abnormal synkinesis are of the greatest rehabilitation value. In the residual period of stroke, persistent abnormal synkinesis can limit voluntary motor skills and require inactivation. In this case, orthopedic fixation, reflex-inhibitory positions, Perfetti therapy, the use of robotic simulators based on biofeedback and virtual reality techniques 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 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. KEYWORDS: global synkinesis, mirror synkinesis, motor irradiation, abnormal coactivation, PNF, rehabilitation