Elaborate Ways for Rehabilitation Stroke Patients Using Drug Treatment with Cerebrolysin vs. Advanced Physical Therapy Techniques

Stroke patients are a major problem for their families because of the weight and limitations of recovery procedures. In this study, it is desired to show the benefits of virtual reality utilization both singularly and in tandem with the drug, namely the dual use of virtual realities and cerebrolysin. The aim of the study was to evaluate the overall functioning of patients diagnosed with stroke and their recovery.We compare patients who received drug treatment and physiotherapy and those who benefited from advanced physiotherapy (assisted by virtual reality) and drug treatment. The study group has a total of 42 participants (15 women and 27 men), of whom 22 received medical treatment and 20 underwent medical treatment and a virtual reality based physical therapy. The study also shows the starting point for rehabilitation respectively that how started rehabilitation prior to the 1-year mark and after the 1 year mark.The analysis was carried out over a period of 1.5 years in the hospital with a specially militarized status for the former patients and followers for a period of 1 years and seeing their evolution in several tests of: balance, posture, speed and assessment of the degree of functionality. The Health Improvement Analysis was done on these parameters and on the answers given in a clinical self-evaluation questionnaire. The physical therapy and exercise added to medical treatment play a considerable part in the recovery of overall functioning of patients with stroke.

Stroke patients are a major problem for their families because of the weight and limitations of recovery procedures. In this study, it is desired to show the benefits of virtual reality utilization both singularly and in tandem with the drug, namely the dual use of virtual realities and cerebrolysin. The aim of the study was to evaluate the overall functioning of patients diagnosed with stroke and their recovery.We compare patients who received drug treatment and physiotherapy and those who benefited from advanced physiotherapy (assisted by virtual reality) and drug treatment. The study group has a total of 42 participants (15 women and 27 men), of whom 22 received medical treatment and 20 underwent medical treatment and a virtual reality based physical therapy. The study also shows the starting point for rehabilitation respectively that how started rehabilitation prior to the 1-year mark and after the 1 year mark.The analysis was carried out over a period of 1.5 years in the hospital with a specially militarized status for the former patients and followers for a period of 1 years and seeing their evolution in several tests of: balance, posture, speed and assessment of the degree of functionality. The Health Improvement Analysis was done on these parameters and on the answers given in a clinical self-evaluation questionnaire. The physical therapy and exercise added to medical treatment play a considerable part in the recovery of overall functioning of patients with stroke.
Key words: Stroke, virtual reality, physio therapy, cerebrolysin, rehabilitation Stroke patients are a major problem for their families because of the weight and limitations of recover y procedures. Besides the special attention that stroke patients must have at risk factors, it is very important to recover them and increase the quality of life at these patients [6,7].
In this study, it is desired to show the benefits of virtual reality utilization both singularly and in tandem with the drug, namely the dual use of virtual realities and cerebrolysin.

Experimental part
The study group has a total of 42 participants (15 women and 27 men), of whom 22 received medical treatment respectably: medical rehabilitation (physical therapy and electrotherapy) accompanied by pharmacological treatment (cerebrolysin) and 20 underwent medical rehabilitation (physical therapy and electrotherapy) accompanied by pharmacological treatment (cerebrolysin) and a virtual reality based physical therapy. Cerebrolysin * email: superstarale@yahoo.com, mada_palfi@yahoo.com administration protocol: 10 consecutive doses of 10 mL i.v. diluted in saline solution 500mL.
Basically the two study lot's have received the same treatment respectably: electrotherapy: toning electrical stimulation for flaccid muscles and decontracturant electrical stimulation for spastic muscles, ultrasound therapy, laser therapy, cryotherapy, shortwave therapy, tecar therapy, shock wave, lymphatic drainage, relaxing massage, physical Therapy: The Kabat method, The Bobath method, The Brunnstrom method, The Jacobson method, Ocupational therapy, Hidro kinetotherapy and the only diference is given throw the application of virtual reality.
The study also shows the starting point for rehabilitation respectively that how started rehabilitation prior to the 1year mark and after the 1 year mark. Table 1 shows an overview of patient characteristics in each group. Statistical tests did not found statistically significant differences of age, gender, stroke etiology proportions, living areas, and body mass index.
An important result was the absence of statistically significant difference regarding the time elapsed from stroke. In order to draft the protocol, the following tests are considered:

10-meter walk test (normal speed)
The test protocol is as follows: Measurement of the depression velocity (m / s) analysis is done at a distance of 10 meters of which 2 meters represent the acceleration phase, the following meters represent the actual travel speed and the last 2 meters represents the deceleration phase. The actual measurement will be made after exceeding the 2-meter line and will cease to reach the 8meter distance and the result as a 6-meter pronounced time enters the mark of 2 and 8 meters respectively will be divided to 6 for the speed playback in meters second according with the existing studies [1].
The test is performed on admission and discharge and the results are compared. Please note that to prevent possible errors, the test is performed 3 times with pauses between repatriations and only when the patient declares that it is at the level of response and the speed in m / s is given as an average displacement value for the 3 sample tests.
The number of steps 10-meter distance As the name suggests, the test refers to the number of steps the patient makes for a distance of 10 meters [2]. This measurement is done by showing the number of steps (entire) even if the patient succeeded with the last step to exceed the mark of 10 meters.

10-meter walk test (swift speed)
The test protocol is as follows: Measurement of the depression velocity (m / s) analysis is done at a distance of 10 meters of which 2 meters represent the acceleration phase, the following meters represent the actual travel speed and the last 2 meters represents the deceleration phase [3]. The actual measurement will be made after exceeding the 2-meter line and will cease to reach the 8meter distance and the result as a 6-meter pronounced time enters the mark of 2 and 8 meters respectively will be divided to 6 for the speed playback in meters second.
The test is performed on admission and discharge and the results are compared. Please note that to prevent possible errors, the test is performed 3 times with pauses between repatriations and only when the patient declares that it is at the level of response and the speed in m / s is given as an average displacement value for the 3 sample tests.

minute walk test
This test measures the distance and the number of steps passed by the wearer and whether it has moved by itself or by means of a locomotive or baton or crutches [4]. The test is performed on admission and discharge and the results are compared [5].

SF-36 Health Questionnaire
The quality of life analysis was done using the standardized questionnaire: SF-36 Health Questionnaire.
The life quality assessment scale was based on the standardized questionnaire used in the medical units. It is a scale that evaluates 6 areas of everyday life.

Experimental part Material and method
Hospital corridor with a length of 100m and markings indicating the distance traveled.
Standardized physical therapy apparatus and treatments according to the respective unit norms (Military Hospital).
Advanced physical therapy techniques (using virtual reality-VirtualRehab). VirtualRehab is a clinically validated and CE certified complement to physiological recovery therapies for the patient with varying degrees of physical disability. It uses motion capture technology from Microsoft® Kinect sensors to turn the patient into a protagonist of video games interacting with 2D and 3D gaming environments. A multidisciplinary group of opinion leaders from neurology and physiotherapy has collaborated to develop VirtualRehab. It has been clinically validated on the basis of studies conducted in 2012. Their results have proven the utility of VirtualRehab in recovering patients combined with traditional therapies and were presented at the 8th World Conference on Neurorecuperation in 2014 in Istanbul. Virtual Rehab has been created to improve the quality of life of patients with neurodegenerative, neuromuscular and neurovascular pathologies and to improve the mobility of the elderly. One of the main benefits of Virtual Rehab systems is that it provides a new and exciting platform for making a number of repeated recovery moves to encourage neuroplasticity. Virtual Rehab offers the only way to include Constraint-Induced Movement Therapy (CIMT) -Induced Constraint Motion Therapy. VirtualRehab is a flexible tool that allows specialists to create complex treatment programs. Combining various therapeutic exercises with the appearance of games, ensures an efficient and engaging recovery process; increases patient satisfaction, leading to greater involvement and visible progress. VirtualRehab Body consists of a set of exercises designed to recover upper and lower limb motor functions for a wide range of neurological pathologies. Through interactive games, the system allows the return of abilities such as balance, body weight transfer, target achievement, muscle tonicity, effort resistance. These are major issues in the daily life of the patient for daily activities: feeding, hygiene, dressing, etc.
One of the first attempts to use virtual reality in the treatment alongside physical therapy was a non- These exercises proved to be a good stimulus both in terms of physical exercise and the morale of many patients who were funny (the statements of the patients who found amusement and hope through these exercises and stated that they gave them a state of calm and reduced anxiety)( fig.1).
The measurement form analyzes data about convenient (normal) and fast (step-by-step) walking on a The 2-minute walk test gathers and analyzes the following data: If walking was done with or with a device or without outside intervention, the distance covered within 2 min and the number of steps made by the patient on that route and whether it was improved as a distance and as a reduction in the number of steps. Tests of continuous variables were carried out after the test of normality.
Unpaired and paired T-tests, as well as Wilcoxon ranksum und signed-rank tests were performed for continuous variables.
Wilcoxon rank-sum test was used for questionnaires, whereas Chi-square test was conducted to test the categorical variables.
The statistical level of significance was set at 0.05, the aforementioned statistical tests being performed with R [X].

Results and discussions
All tests from table 2 did not show a statistically significant difference between groups at admission.    Statistical tests from table 4 pointed out more improvements in group 2 than in group 1. The absence of significant differences at admission allowed a comparison of groups at discharge.
The results confirm the utility and usability of the digital patient in clinical reasoning and in educational applications as also confirmed by other studies [9,10].
As for exposure riscks Microsoft Kinect is a marker less body scanning sensor based on an infra-red structured light architecture the harmful exposure of the screened patients is reduced to zero [11]. Apart from its utility to analyze clinical and electrophysiological parameters [12,13].
Although tests from table 4 showed few improvements also in group 1, results from table 5 emphasized better outcomes of patients from group 2 regarding Step length and two-minute walk test.
Therefore, results from tables 4 and 5 revealed an improvement in the dual-treatment group with virtual reality and drug treatment over those who only benefited from drug treatment.
Also, the group that benefited from a virtual rehabilitation treatment onset before the one-year point experienced a greater improvement over those who benefited from dual treatment after one year.
Thus a complex medical rehabilitation therapy that is sustained and established early, can help improve an individualized recover y program (virtual recover y treatment).

Conclusions
The results revealed a significant improvement in the dual-treatment group over those who only benefited from drug treatment.
The group that benefited from a virtual rehabilitation treatment onset before the one-year point experienced a greater improvement over those who benefited after one year.
Thus complex medical rehabilitation therapy sustained and established early, can help improve an individualized recovery program (virtual recovery treatment).