Clinical and functional rationale for the use of non-pharmacological treatment in patients with visual impairments after stroke: a single-center controlled trial

Vollständiger Abstract

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INTRODUCTION. Each year, over 12 million new stroke cases are reported globally, with up to 50 % of survivors experiencing persistent neurological deficits. The most common among these deficits is post-stroke spasticity. The incidence of spasticity ranges from 20 to 40 % during the early rehabilitation period, and increases to 50–60 % among patients with hemiparesis in the later stages following a stroke. It is important to emphasize that a patient’s recovery after a stroke should not be limited solely to addressing motor impairments. AIM. To evaluate the effect of a comprehensive program combining reflexology and occupational therapy on spasticity and functional mobility, with a focus on short-term outcomes and quality of life in patients with post-stroke spasticity and visual impairments. MATERIALS AND METHODS. A single-centre controlled study included 40 patients in the early recovery phase of an ischaemic stroke (up to 6 months) with spasticity rated 1–3 on the modified Ashworth scale and objectively confirmed visual impairments. The main group, in addition to standard health resort treatment, received a course of reflexotherapy (10 sessions) and occupational therapy (10 sessions). Alongside traditional scales (the Modified Ashworth Scale (MAS), the Barthel Index, the Quality of Life Assessment (EQ-5D-5L) and others), particular attention was paid to timed tests — the Timed Up Go test and the time taken to perform basic self-care tasks. The study was conducted in the premises of the National Medical Research Centre for Rehabilitation and Balneology of the Russian Ministry of Health, between 2024 and 2026. RESULTS. The intervention group demonstrated a significant reduction in spasticity (MAS from 2 [1; 3] to 1 [1; 2] points; p = 0.001) and marked improvement in temporal mobility measures: Timed Up and Go test time decreased from 25.0 [22.5; 28.0] to 22.0 [20.0; 25.0] sec (p = 0.02), while the duration of dressing and eating tasks decreased by an average of 25–30 %. Furthermore, daily living independence rose (Barthel Index from 65 to 85 points; p = 0.0004), quality of life (EQ-5D-5L) improved, and anxiety-depressive symptoms decreased (Hospital Anxiety and Depression Scale (HADS); p 0.01). No adverse events were recorded. DISCUSSION. The use of reflexology and occupational therapy is accompanied by an improvement in the quality of life, a decrease in anxiety and depression, as well as a decrease in pain, which indicates a systemic positive effect on the psycho-emotional status and quality of life of patients. Therefore, the proposed program is characterized by high safety (there were no adverse events) and good tolerability, which makes it possible to recommend it for widespread implementation in health resort institutions providing medical rehabilitation to patients after a stroke. CONCLUSION. The combined use of reflexotherapy and occupational therapy in patients with post-stroke spasticity and visual impairments is a safe and effective method that not only reduces muscle tone but also significantly improves temporal characteristics of motor activity and everyday independence. These findings justify the inclusion of this programme in the standards for health resort rehabilitation to address both motor and time-related functional impairments.