Modern approaches to physical rehabilitation of patients after stroke: analysis of effective methods of movement therapy

Abstract

The purpose of this review is to analyse current approaches to physical rehabilitation of patients after stroke, assess their effectiveness based on recent clinical trials and identify promising areas for the development of neurorehabilitation, as well as to summarise and systematise the available evidence on kinesiotherapy in post-stroke rehabilitation.Materials and methods. The study materials included systematic reviews, meta-analyses and original clinical trials on various aspects of physical rehabilitation for stroke patients. The main focus was on the following methods: – Functional training: exercises that mimic everyday movements. – Forced movement therapy (CIMT): Restricting the healthy limb to stimulate the affected limb. – Robotic rehabilitation: the use of exoskeletons and robotic devices. – Hydrokinesiotherapy and aerobic training: physical exercises in water and cardio exercise. – Functional electrical stimulation (FES): the use of electrical impulses to stimulate muscles. – Virtual reality (VR): interactive systems with biofeedback. – Kinesiotaping: the use of special elastic patches. – Traditional methods: proprioceptive neuromuscular stimulation (PNF) and the Bobath concept.The research methods consisted of a systematic review and analysis of scientific literature. The effectiveness of each method was assessed based on published data, the results were compared, and advantages and limitations were identified. Mechanisms of action were analysed, including stimulation of neuroplasticity, normalisation of muscle tone and activation of cortical-spinal pathways.The scoring scales used (e.g., Fugl-Meyer, Barthel, Rankin, NIHSS) and methodological features of the included studies were also considered.Results. A literature review has confirmed that kinesiotherapy is a highly effective tool in restoring motor function after stroke, especially when integrated with modern technologies. – Functional training increases motor recovery by 35–40% compared to passive exercises. – CIMT therapy increases the range of motion in a paretic limb by 30–40%, and its combination with transcranial magnetic stimulation increases efficiency by 37%. – Robotic rehabilitation significantly improves the range of motion, walking speed and functional performance, ensuring high accuracy and repeatability of movements. – Hydrokinesiotherapy and aerobic training improve physical endurance, cognitive function and reduce the risk of recurrent stroke. – Functional electrical stimulation (FES) effectively reduces spasticity and improves muscle activity, with personalised approaches allowing for a high degree of compliance with physiological movement patterns. – Virtual reality (VR) shows 31% better results in restoring upper limb function, increasing patient motivation and improving coordination.At the same time, a number of limitations have been identified, including the small sample size and short duration of most studies, the lack of standardised kinesiotherapy protocols, uneven use of assessment scales, and insufficient consideration of individual patient characteristics. The high cost and limited availability of some innovative technologies are also obstacles.Conclusions. The evidence base confirms that kinesiotherapy, especially in combination with modern technologies, provides significant functional improvement in stroke patients in both the acute and chronic periods. Its benefits include individualisation, sensorimotor stimulation and active patient participation, which helps to activate neuroplastic processes and improve quality of life.A modern rehabilitation strategy should be based on an individualised approach that combines early mobilisation, intensive motor training, aerobic exercise, CIMT and innovative technologies (VR).Prospects for further research include the development and evaluation of personalised rehabilitation programmes using artificial intelligence, standardisation of kinesiotherapy protocols, long-term studies to assess cognitive and psycho-emotional effects, and in-depth integration of new technologies with an assessment of their economic feasibility. Comparative studies with alternative methods and an in-depth study of neuroplasticity mechanisms are needed to develop more effective strategies.