Post-stroke motor disorders: pathogenetic mechanisms and modern approaches to treatment and rehabilitation

Post-stroke motor disorders are among the leading causes of long-term disability and reduced quality of life in patients who have experienced a stroke. Their structure includes paresis, impaired movement selectivity, pathological synergies, spasticity, as well as disorders of gait, balance, and postural control. In recent years, concepts of the pathogenesis of post-stroke motor deficit have undergone a significant transformation, shifting from lesion-based localization to network models of dysfunction and neuroplastic reorganization of the central nervous system. Objective: to summarize current data on pathogenetic mechanisms of post-stroke motor disorders and to analyze evidence-based therapeutic and rehabilitation approaches to motor function recovery after stroke.

Results. Recent publications indicate that severity and pattern of post-stroke motor impairments are determined by the extent of corticospinal tract damage, interhemispheric imbalance, maladaptive plasticity, and impaired sensorimotor integration. Spasticity is considered a multicomponent motor disorder combining neurogenic and musculoskeletal–biomechanical mechanisms. Contemporary rehabilitation strategies rely on early initiation, adequate intensity, and task-oriented training. The effectiveness of robot-assisted therapy, virtual reality, functional electrical stimulation, and constraint-induced movement therapy has been demonstrated as means of increasing the dose and quality of motor practice. Non-invasive neuromodulation (rTMS, tDCS) and vagus nerve stimulation combined with active rehabilitation are regarded as promising adjuvant methods. Treatment of post-stroke spasticity, including botulinum toxin, is most effective when integrated with active training programs. Telerehabilitation has shown non-inferiority to standard approaches in certain clinical settings and expands access to long-term rehabilitation care. Conclusion. Post-stroke motor disorders have a complex multilevel pathogenesis and require a personalized, multidisciplinary approach. The greatest functional benefit is achieved by combining intensive motor learning with modern technological and neuromodulatory methods.

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