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Motor rehabilitation is one of the key tasks for the recovery of personal independence of patients suffering a stroke. Neuromuscular electrostimulation synchronized with the performance of a motor task, known as functional electrical stimulation (FES), is a proven and widely used method. Specialists have established the principles of safe neuromuscular stimulation, as well as the methods aimed at increasing strength in affected muscles, over more than a 40-year history of FES studies. This review presents information about the novel FES technologies, clinical and basic studies, and discusses prospects for future research areas.

The problem of rehabilitation of stroke patients is being actively developed in modern medicine. According to the World Health Organization, 100-300 cases of stroke occur annually in developed countries for every 100 thousand people. In Russia, these numbers are 250-320 among the urban population (according to the registers of cerebral stroke in Moscow and Novosibirsk) and 170 among the rural population (according to the Stavropol Territory).

The mechanisms of the organization of goal-directed movements in the human arm have received insufficient study. The processes of cortical reorganization on the background of learning new skills and rehabilitation after central nervous system disease are of particular interest. Studies of the motor system and recording of neurophysiological parameters determining the kinematic characteristics of movements at the cortical level use navigated transcranial magnetic stimulation. The present study of 20 healthy volunteers randomized to study and control groups assessed resting motor thresholds, cortical motor representation zones of the extensor digitorum communis muscle in terms of areas and weighted areas, and the displacement of the centers of gravity on the background of training to motor imagery using a brain–computer interface. No significant differences were found between these parameters in the study group and the control group.

This review presents current data on possible mechanisms forming synergies in health, particularly at the cortical level. The mechanisms of formation of pathological synergies, taking account of the anatomical and physiological characteristics of the upper limbs and the hypothesis, that synergistic patterns are transformed in patients with spastic hemiparesis are discussed. Current views of the pathophysiological bases of the formation of pathological synergies based on neuroimaging and neurophysiological study data are presented, along with a method for noninvasive stimulation of the brain. The question of the correction and transformation of pathological synergies in rehabilitation practice is discussed. Particular attention is paid to clinical and instrumented evaluation of synergies and the use of validated clinical scales and instrumented methods such as video movement analysis, electromyography, magnetic and contactless tracking systems, and virtual reality technologies.

The purpose of the study is an analysis of the consumption of antibacterial drugs in the therapy of salpingoophoritis in hospital settings and evaluation of changes in the real clinical practice of antibiotic therapy after the introduction of the “Order of medical care for the profile “obstetrics and gynecology...”. Materials and methods. In a retrospective study, an assessment was made of the prescriptions of antibacterial drugs in the therapy of salpingoophritis in specialized treatment and prophylactic institutions of the city of Tomsk in the period 2010–2014. The analysis included 160 case histories. The structure of prescriptions was evaluated on the basis of the application of anatomical-therapeutic-chemical classification and international non-proprietary names (INN), the structural improvement factor K. Gatev was calculated. To quantify the consumption of medications, the calculated daily dose (PDD) was used. Results. Comparative analysis of antibacterial therapy of salpingoophoritis in hospital before and after the introduction of the “Order of medical care for the profile of «obstetrics and gynecology...”. Leading groups of antibacterial drugs were identified. А comparative analysis of the frequency of assignment of various INN was made. The К. Gate’s coefficient was 0.281. The calculation of the average prescribed daily doses of antibacterial drugs was performed. Conclusion. The review of the consumption of antibacterial drugs for salpingoophoritis therapy in hospital settings before and after the introduction of the “Order of medical care for the profile “obstetrics and gynecology...”, showed that the range of antibacterial drugs used increased from 18 to 24 INN, mainly due to the inclusion of modern medicines. In the structure of appointments in 2013–2014, the proportion of drugs not recommended for use by the «Order of medical care for the profile of «obstetrics and gynecology» was 37.5%. It was found that PDD clarithromycin, clindamycin and cefotaxime did not meet the recommended dosing regimens specified in the clinical recommendations for antibiotic therapy. The gap between actual clinical practice and existing clinical recommendations determines the need for in-depth pharmacoepidemiological evaluation to identify the causes and develop measures of an organizational and educational nature to optimize the use of medications.

In recent decades, interest in studies on basic and applied aspects of how the nervous system functions has been growing rapidly around the world. The recovery of lost functions rests on processes of neuroplasticity, which is determined by the ability of the brain to transform its structures in response to injury. The effects of both routine and state-of-the-art neurorehabilitation technologies are ensured by synaptic plasticity— long-term potentiation and long-term depression, which influence learning and the preservation of new knowledge and skills obtained during rehabilitation. The introduction of new methods of neuroimaging, neurophysiology, and mathematical statistics have powerfully stimulated the development of the neuroplasticity doctrine. It has become clear that the main role in the recovery of injured functions is played by the reorganization of cortical nets and not by tissue reparation as such. The Research Center of Neurology has accumulated significant experience in the use of innovative treatment methods based on modern neurorehabilitation principles. Some of them are used for acute stroke; among other things, their effectiveness and safety have been shown with regard to patients in intensive care units (cyclic robotic mechanotherapy) and patients with severe motor deficit and an associated somatic pathology (stimulation of plantar support zones). Opportunities to assess neuroplasticity under various rehabilitation methods using fMRI and navigated transcranial magnetic stimulation (TMS) are revealed. The center also studies the fundamentals of consciousness using original neuroimaging and neurophysiological protocols for the sake of its recovery. The center is actively introducing its data into the practice of domestic clinics specializing in recovery medicine and neurorehabilitation.

Cerebrovascular diseases seriously reduce the quality of life of patients. One of the priority tasks of restoring individual independency, daily living and social activity of patients is to restore basic motor skills such as the reaching, manipulating, and bimanual tasks an coordination. For successful recovery of movement necessary to conduct training in real environment, active participation of the patient, and interactive biofeedback that allows the patient to control the correct performance of motor tasks and adjust their own efforts. Evolution of computer technology gives an opportunity to improve the classical approaches in stroke rehabilitation. To make rehabilitation process met necessary terms, in everyday practice often used high technological devices, such as virtual reality (VR) systems. The technical basis of VR is an artificial three-dimensional environment that is created with computer and displayed on the screen. These technologies allow recreating the necessary training environment for motor skills relearning, as well as to provide interactive biofeedback and make rehabilitation process more intensive. This review present an information about history of VR technology developments, experience of upper limb rehabilitation using VR systems and comparative analysis of different VR based rehabilitation approaches.

This review discusses the functioning of the motor system under normal and reduced gravity. Analysis of the experimental data led to the conclusion that all changes in the functioning of tonic muscular system are related to each other. When transiting to the state of microgravity, changes are caused by one common factor, namely a sharp decrease in the activity of support afferent input, specifically oriented to the perception and analysis of gravitational loads and firmly embedded in the mechanisms of postural synergism organization. We analyzed data obtained in studies on the activation of cortical areas of the brain during the stimulation of support afferents in order to test the hypothesis that such stimulation in both healthy subjects and patients with neurologic deficiency leads to activation of both the sensory and motor cortex involved in supraspinal control of the movement of the lower limbs, in particular when walking.

Transcranial magnetic stimulation (TMS) is a new technique that results in neuron excitation using alternating magnetic fields. According to recent reports, high-frequency TMS could be an effective treatment for drug-resistant central post-stroke pain (CPSP). The present case report describes the clinical observation of two patients with CPSP with different lesion localisations and volumes. High frequency (10 Hz) TMS of the primary motor cortex of the affected hemisphere was used in each patient. After stimulation, we recorded a significant reduction in pain on a visual analogue scale (VAS). However, after the end of treatment with TMS, pain gradually returned to previous levels after 3–4 months.

The mechanisms underlying the locomotion recovery in poststroke patients remain unknown. Navigated transcranial magnetic stimulation (nTMS) is a new method to evaluate the functional state of the motor system. Using of the “Regent” soft exoskeleton complex (SEC) allow to correct walking pattern significantly. The aim of this study was to evaluate the capability of nTMS to assess changes in gait cortical control using SEC in poststroke patients. 14 patients of the subcortical stroke (the mean age was 53.0 years, the mean time from stroke onset was 14.2 months) received 10 training sessions with SEC. The patients received nTMS before and after the sessions, as well as they were clinically evaluated by the Fugl–Meyer scale section for lower extremity and a 10-m walk test. Whereas a reliable reduction in the time of walking for 10 m was recorded after the sessions with the application of SEC, the Fugl-Meyer scale assessment remained unchanged. During nTMS, a reduction was recorded in the average latency of evoked motor response from the affected hemisphere, as well as various patterns of changes in the size and localization of cortical representations of the leg muscles. We have concluded that the nTMS method allowed us to identify the individual patterns of changes in the cortical representations of leg muscles as a result of the use of SEC in post-stroke patients with injuries in a group of locomotor system elements, thus identifying not only the fact of the undergoing neuroplastic processes, but also their direction.

Pharmacoepidemiological and pharmacoeconomical analysis of endometrit drug therapy at special treatment-and-prophylactic institutions of the city of Tomsk. Estimate the intensity of the appointment of antibacterial drugs endometrit therapy using the methodology of the WHO ATC/DDD, calculated indicators of the intensity of the consumption of drugs in the course of treatment per patient. It was shown that 70% of the established daily dose had to beta-lactam antibiotics and macrolide. For the most common options for antibiotic therapy established nosology of the indicators of clinical efficacy. The calculation of the cost of the schemes of antibiotic therapy, which showed that the cost of treatment is maximal during therapy with ceftriaxone + clarithromycin (4902 RUR); further descending follow: amoxicillin / clavulanic acid + roxithromycin (4658 RUR); benzylpenicillin and gentamicin (4231 RUR). Economic efficiency of antibacterial treatments endometritis a “cost – effectiveness”. The cost of the patient, achieved remission, made during therapy with amoxicillin/clavulanic acid and roxithromycin (5416 RUR), During therapy with ceftriaxone and clarithromycin (6052 RUR), the treatment of benzylpenicillin and gentamicin (14420 RUR). Pharmacoeconomic evaluation results showed that the least acceptable scheme of antibacterial therapy of endometrit in the hospital is the combination of benzyl penicillin and gentamicin. Тhe antibiotic therapy for endometrit may be recommended by a combination of amoxicillin / clavulanic acid and roxithromycin and clarithromycin and ceftriaxone, for which there was no statistically significant differences in clinical efficacy and cost of antibiotic therapy.

The mechanisms underlying the locomotion recovery in poststroke patients remain unknown. Navigated transcranial magnetic stimulation (nTMS) is a new method to evaluate the functional state of the motor system. Using of the exoskeleton complex (EC) allow to correct walking pattern significantly. The aim of this study was to evaluate the capability of nTMS to assess changes in gait cortical control using EC in poststroke patients. 14 patients suffered subcortical stroke, mean age was 53.0 years [49, 62], mean duration of a stroke of 14.2 [7.0; 23.0] months were included. All patients trained with EC for 10 times and also received standardized physical therapy. All patients underwent nTMS, as well as clinical assessment using a Fugl-Meyer Scale lower extremity section and 10 m walking test before and after trains. A significant decrease of time to walk 10 meter was observed, while Fugl-Meyer Score remained unchanged. Patients showed the significant reduction of the average latency of motor responses from the affected hemisphere and different patterns of size and localization changes in both legs' cortical motor areas. Navigates TMS may demonstrate individual patterns of changes in cortical representation of leg muscles in post-stroke patients with damage of various motor system elements, while using exoskeleton complex. Thus, navigated TMS may be used not only for verification of neuroplasticity process, but it may also provide its detailed description.

Introduction Spasticity is associated with various diseases of the nervous system. Current treatments such as drug therapy, botulinum toxin injections, kinesitherapy, and physiotherapy are not sufficiently effective in a large number of patients. Transcranial magnetic stimulation (TMS) can be considered as an alternative method of treatment. The purpose of this article was to conduct a systematic review and meta-analysis of all available publications assessing the efficacy of repetitive TMS in treatment of spasticity. Evidence acquisition Search for articles was conducted in databases PubMed, Willey, and Google. Keywords included "TMS", "spasticity", "TMS and spasticity", "non-invasive brain stimulation", and "non-invasive spinal cord stimulation". The difference in scores according to the Modified Ashworth Scale (MAS) for one joint before and after treatment was taken as the effect size. Evidence synthesis We found 26 articles that examined the TMS efficacy in treatment of spasticity. Meta-analysis included 6 trials comprising 149 patients who underwent real stimulation or simulation. No statistically significant difference in the effect of real and simulated stimulation was found in stroke patients. In patients with spinal cord injury and spasticity, the mean effect size value and the 95% confidence interval were -0.80 and (-1.12, -0.49), respectively, in a group of real stimulation; in the case of simulated stimulation, these parameters were 0.15 and (-0.30, -0.00), respectively. Statistically significant differences between groups of real stimulation and simulation were demonstrated for using high-frequency repetitive TMS or iTBS mode for the M1 area of the spastic leg (P=0.0002). Conclusions According to the meta-analysis, the statistically significant effect of TMS in the form of reduced spasticity was demonstrated only for the developed due to lesions at the brain stem and spinal cord level. To clarify the amount of the antispasmodic effect of repetitive TMS at other lesion levels, in particular in patients with hemispheric stroke, further research is required.

Motor imagery can stimulate the same neuroplastic mechanisms of the brain as their actual execution. The motor imagery can be controlled via the brain–computer interface (BCI), which transforms the EEG signals of the brain appearing during the motor imagery into commands for the external device. The results of the two-stage study of the application of a non-invasive BCI for the rehabilitation of patients with marked hemiparesis resulted from a local brain injury. We have shown that the learning to manage the BCI does not depend on the duration of disease, localization of the damaged site, and the severity of neurological deficit. The results of the first stage of the study carried out in a group of 36 patients showed that the rehabilitation therapy was more effective in the group that was trained to manage the BCI (the ARAT score improved from 1 [0; 2] to 5 [0; 16], p = 0.012 in the BCI group; no significant improvement was detected in the control group). In the second phase of the study, 19 patients participated in the testing of a BCI–exoskeleton system. Rehabilitation based on this technology led to an improvement of the motor function of an arm from 2 [0; 37] to 4 [1; 45.5], p = 0.005, according to the ARAT scale, and from 72 [63; 110] to 79 [68; 115], p = 0.005, according to the Fugl-Meyer scale.

The effect of a treatment course with a Regent multimodal complex exoskeleton (MCE) on the reorganization of cortical locomotor zones was studied in 14 patients with post-stroke hemiparesis, mainly in the chronic stage of the disease. Specific activation zones were identified prior to treatment in the primary sensorimotor and supplementary motor areas and the inferior parietal lobules of both affected and healthy hemispheres by functional magnetic resonance imaging (fMRI) used in a special passive sensorimotor paradigm. After a treatment course with the MCE, temporal characteristics of walking were found to improve, which was accompanied by a decrease in the activation zones of the inferior parietal lobules, especially in the healthy hemisphere, and a significant increase in the activation zones of the primary sensorimotor and supplementary motor areas. Significant changes in intrahemispheric and interhemispheric interactions were revealed by analyzing the functional connectivity of the zones under study before and after a course of treatment with the MCE.

the relevance of this study arises from the high prevalence of upper limb motor impairment and pathological synergy in the post-stroke patients; these conditions are very difficult to correct with the use of the traditional rehabilitation methods. A promising but insufficiently studied approaches are the virtual reality (VR) technology as well as its combination with other techniques.The objective of the present study was to evaluate the influence of the training making use of the mechanotherapeutic system on the motor function of the paretic hand.A total of 30 patients were enrolled in this study. The main group comprised 20 of them who completed the training course on the mechanotherapeutic system allowing for separate adjustment of weight support for the shoulder and the forearm, VR feedback with individual setting of the active working space, and augmented functional exercises. The control group consisted of the patients (n=10) who performed the task-oriented motor training course of an equal duration with arm weight support and visual feedback.The assessment based on the Fugl-Meyer scale (FMA) showed the statistically significant changes in the passive motion range in the patients of both groups, but only those comprising the main group were found to experience the improvement of the major movements of the arm, wrist, and hand as well as movements outside synergy (p0.005). Fine motor skills estimated from the results of the Action Research Arm test (ARAT) improved only in the main group due to the cylindrical and pinch grip (p0.005). Also, only patients of the main group, improved daily living skills evaluated based on the Frenchay Arm test (FAT) (p0.005).The results of the present study give evidence that the use of combined training with arm weight support and VR feedback contributes to a more complete recovery of motor and daily living skills in the upper limb of post-stroke patients, compared to the classical task-oriented training with visual feedback.Актуальность проблемы продиктована высокой распространенностью двигательных нарушений руки у пациентов, перенесших инсульт, и частотой развития патологических синергий в ней, препятствующих эффективному восстановлению ее функции с помощью традиционных методов реабилитации. Перспективным, но недостаточно изученным методом является технология виртуальной реальности, а также ее комбинация с другими методиками. Цель — изучить влияние тренировок с помощью механотерапевтического комплекса на двигательную функцию паретичной руки. Материал и методы. В исследование были включены 30 пациентов: 18 мужчин и 12 женщин. Все больные были разделены на две группы: основную и контрольную. Пациенты основной группы (n=20) проходили тренировку на механотерапевтическом комплексе с раздельно настраиваемой для плеча и предплечья разгрузкой веса, виртуальной обратной связью с индивидуальным подбором площади активной рабочей зоны, а также с помощью функциональных упражнений с расширенной обратной связью. Пациенты контрольной группы (n=10) получали эквивалентный по продолжительности курс тренировок с применением методики целенаправленного двигательного обучения с разгрузкой веса руки и зрительной обратной связью. Результаты. По шкале Фугл—Мейера у пациентов обеих групп были отмечены статистически значимые изменения объема пассивных движений, однако только в основной группе были зафиксированы достоверные улучшения крупных движений руки, движений запястья и кисти, а также движений вне синергий (p0,005). Навык мелкой моторики кисти по шкале оценки функции руки (Action Research Arm test) изменился только в основной группе за счет улучшения цилиндрического и щипкового захватов (p0,005). Также только в основной группе достоверно улучшились навыки бытовой активности по тесту Френчай (p0,005). Обсуждение. Полученные результаты свидетельствуют о значимом увеличении объема активных движений в основной группе, снижении двигательной компенсации со стороны крупных мышц плечевого пояса при выполнении движений (достижение объекта и его последующего захвата) паретичной рукой. Кроме того, проведение занятий с использованием разгрузки паретичной руки способствовало большей интенсивности тренировочного процесса (увеличению повторов упражнений) без чрезмерного утомления пациента, что, в свою очередь, давало возможность увеличивать продолжительность занятий. Заключение. Таким образом, применение комбинированной тренировки с разгрузкой веса руки и виртуальной обратной связью способствует более полному восстановлению двигательных и базовых бытовых навыков у пациентов, перенесших инсульт, в отличие от классической целенаправленной тренировки со зрительной обратной связью.

Early stage Parkinson’s disease (PD) shares certain symptoms with essential tremor (ET), which makes it difficult to differentiate between the two. We analyzed cyclical body bends to find kinematic parameters that are capable of differentiating among PD, ET and normal control (NC) subjects. A linear discriminant analysis of the joint angles showed a reliable distinction between NC and the two groups of patients, while differentiating reasonably well between PD and ET. PD patients showed difficulty performing hip segment rotation around the vertical axis, whereas ET patients demonstrated enlarged torso sway in the frontal plane. These findings suggest that kinematic parameters of body movement in the standing position are sensitive enough to serve as subclinical marks in the early diagnosis of PD and ET.

The physiological mechanisms underlying the process of motor imagery have significant similarities with the mechanisms of motor control, and this can be used for the rehabilitation of patients with movement disorders. In patients with severe paresis, motor imagery may be the only method producing movement recovery. Over the last decade, this has led to increasing interest in studies of the function of motor imagery. Brain–computer interface technologies can be used monitor training with imaginary movements.

The sources of brain activity that make the maximum contribution to EEG patterns corresponding to motor imagery have been studied. The accuracy of their classification determines the efficiency of brain-computer interface (BCI) for controlling external technical devices directly by brain signals, without the involvement of muscle activity. Brain activity sources are identified by independent component analysis. The independent components providing the maximum BCI classification accuracy are considered relevant for the motor imagery task. The two most relevant sources exhibit clearly marked event-related desynchronization and synchronization of the μ-rhythm during the imagery of contra- and ipsilateral hand movements. These sources were localized by solving the inverse EEG problem with due consideration for individual geometry of the brain and its covers, as determined by magnetic resonance imaging. Each of the sources was shown to be localized in the 3a area of the primary somatosensory cortex corresponding to proprioceptive sensitivity of the contralateral hand. Their positions were close to the foci of BOLD activity obtained by fMRI.

Parkinson's disease (PD) is a progressive neurodegenerative disorder, ones of the main symptoms of which are hypertonicity and emergent difficulties during performance of stepping movements due to increased muscle stiffness. Biomechanical (stiffness) and electrophysiological (shorting reaction) characteristics of hip and shank muscles were examined in 25 patients with mild and moderate stages of PD (1 to 3 of Hoehn & Yahr Rating Scale, 61 +/- 9 years) and 22 age-matched healthy controls in unloading leg conditions during passive flexion/extension of hip, knee and ankle joints, as well as the changes of tonic state under levodopa influence. The data obtained were compared with similar findings of healthy subjects. Essentially greater stiffness in all leg muscle groups (with the exception of foot extensors) were observed in patients as compared with healthy. During passive movements the shorting reactions (SR) in hip and shank muscles were often observed, in healthy subjects the SR were observed more rarely. In patients with PD the values of SR in extensors of hip and shank, as well as in flexor and extensor muscles of foot were essentially greater then in healthy. The medicine essentially reduced the stiffness of hip flexors and flexors and foot extensors. The SR were persisted but the frequency of its appearance was decreased in half of investigated muscles, and significant decreasing of SR amount was observed in extensors of foot. The medicine did not exert influence upon SR in proximal muscles. Thus, increasing muscle stiffness in patients with PD is manifested in uncorrected reactions on external disturbances and reflected in increasing of reflectory reaction of muscles.

In a chronic and disabling disease like multiple sclerosis, rehabilitation programs are of major importance for the preservation of physical, physiological, social and professional functioning and improvement of quality of life. Currently, it is generally assumed that physical activity is an important component of non-pharmacological rehabilitation in multiple sclerosis. Properly organized exercise is a safe and efficient way to induce improvements in a number of physiological functions. A multidisciplinary rehabilitative approach should be recommended. The main recommendations for the use of exercise for patients with multiple sclerosis have been listed. An important aspect of the modern physical rehabilitation in multiple sclerosis is the usage of high-tech methods. The published results of robot-assisted training to improve the hand function and walking impairment have been represented. An important trend in the rehabilitation of patients with multiple sclerosis is the reduction of postural disorders through training balance coordination. The role of transcranial magnetic stimulation in spasticity reducing is being investigated. The use of telemedicine capabilities is quite promising. Due to the fact that the decline in physical activity can lead to the deterioration of many aspects of physiological functions and, ultimately, to mobility decrease, further research of the role of physical rehabilitation as an important therapeutic approach in preventing the progression of disability in multiple sclerosis is required.

The space medicine data on the nature of motor disorders suggest an important role of the support inputs in the control of mammalian tonic and postural systems. Progress in functional magnetic resonance tomography (fMRT) makes it possible to perform in vivo analysis of various brain areas during stimulation of the support afferentation. Under these conditions, specific activation of the brain cortical areas was studied in 19 healthy subjects (with the mean age of 38 ± 15.13 years) and 23 patients (with the mean age of 53 ± 9.07 years) with focal CNS lesions (cortical-subcortical ischemic stroke). During scanning of subjects, the support areas of the soles of the feet were stimulated using a block design to simulate slow walking. In healthy subjects, significant activation was recorded (p < 0.05 at the cluster level) in the primary somatosensory cortex, premotor and dorsolateral prefrontal cortex, and insular lobe. In patients that had had a stroke, activation of the locomotion-controlling supraspinal systems clearly depended on the stage of the disease. In patients with a cortical-subcortical stroke, the pattern of contralateral activation of the sensorimotor locomotion predominated during motility rehabilitation.

Methods that, on the one hand, can ensure patient’s mobility and, on the other hand, activate afferent inputs are the main in the rehabilitation treatment. Recent studies have shown that plasticity is the structural basis of recovery after central nervous system lesions. Reorganization of cortical areas, increase in the efficiency of the functioning of preserved structures; and active use of alternative ascending pathways, e.g., intensification of afferent input, constitute the anatomical basis of plasticity. However, sensory correction methods, without accounting of functional condition of patients, may lead to the formation of pathological symptoms: spasticity, hyperreflexia, etc. So, the main aim is to study adequate management of the neuroplasticity process. This problem cannot be solved without modern methods of neuroimaging and brain mapping. The new approach for the study of cortical mechanisms of neuroplasticity, responsible for locomotion, was developed in the present study. This approach is an integrated use of functional magnetic resonance imaging (fMRI) and navigation transcranial magnetic stimulation (nTMS). It has been shown that vast fMRI activation area in the first and second sensorimotor areas emerges with a passive sensorimotor paradigm usage that imitates backing load during walking. The Korvit mechanical stimulator of backing zones of footsteps is used to create this paradigm. The nTMS examination used after fMRI helps to localize motor representation of muscles which control locomotion more accurately. We assume that the new approach can be used for studying the neuroplasticity process and assessing neuroplasticity changes when taking rehabilitation measures to restore and correct the walking process.

The neurophysiological prerequisites for the development and operation of the brain-computer interfaces (BCI) that allow cerebral electrical signals alone to control external technical devices are considered. A BCI based on the discrimination of the EEG patterns related to imagery of extremity movements is described. The possibility of the rehabilitation of patients with motor disorders by means of the BCI based on motor imagery and the exoskeleton controlled by it is discussed.

The mechanisms underlying the process of motor imagery are similar to the motor control mechanisms. It can be used for motor learning in patients with movement disorders. Motor imagery may be the only one method for recovery of motor function in patients with severe paresis. It was the prerequisite of increased scientist interest in motor imagery during last decade. Brain-computer interface technology can support the motor imagery trainings.

The article discusses the effect of a course of treatment with the use of multimodal complex exoskeleton (MCE) "Regent" on the reorganization of cortical locomotor zones in 14 patients with post-stroke hemiparesis, mainly atthe chronic stage of the disease. Before the course of treatment, we identified specific areas of activation in the primary sensorimotor and supplementary motor areas and the inferior parietal lobules in both affected and healthy hemispheres by means of functional MRI (fMRI) with the use of special passive sensorimotor paradigms. After the course of treatment with MCE, we observed an improvement of temporal characteristics of walking; it was accompanied by a decrease in the activation zones of inferior parietal lobules, especially in the healthy hemisphere, and by a significant increase in the activation zone of primary sensorimotor and supplementary motor areas. The analysis of the functional connectivity of studied zones before and after the course of treatment with MCE showed significant changes in intra- and interhemispheric interactions.

Transcranial magnetic stimulation (TMS) is a method based on the excitation of neurons in the brain cortex by an alternating magnetic field. Repetitive TMS (rTMS) is a kind of stimulation, in which a series of pulses are generated. rTMS can modulate different cortical area's activity and change their interactions using different protocols. The review shows the application of rTMS in treatment of various neurological (stroke, Parkinson's disease, dystonia, chronic pain syndromes, tinnitus, epilepsy, spasticity syndrome) and psychiatric (depression and anxiety) disorders. Authors collected all the main protocols, and gave recommendations for their use in clinical practice according to principles of evidence medicine.Транскраниальная магнитная стимуляция (ТМС) - метод, основанный на возбуждении нейронов головного мозга переменным магнитным полем. Ритмическая ТМС (рТМС) - вид стимуляции, при которой генерируется серия импульсов. С помощью различных протоколов рТМС можно оказывать модулирующее воздействие на зоны коры головного мозга. В обзоре рассматривается применение рТМС для лечения неврологических (инсульт, болезнь Паркинсона, дистонии, хронические болевые синдромы, тиннитус, эпилепсия, синдром спастичности) и психических (депрессивные и тревожные расстройства) заболеваний, представлены основные протоколы, даны рекомендации по использованию их в клинической практике в соответствии с принципами доказательной медицины.

The paper examines sources of brain activity, contributing to EEG pat- terns which correspond to motor imagery during training to control brain-computer interface. To identify individual source contribution into electroencephalogram recorded during the training Independent Component Analysis was used. Then those independent components for which the BCI system classification accuracy was at maximum were treated as relevant to performing the motor imagery tasks, since they demonstrated well exposed event related de-synchronization and event related synchronization of the sensorimotor -rhythm during imagining of contra- and ipsilateral hand movements. To reveal neurophysiological nature of these com- ponents we have solved the inverse EEG problem to locate the sources of brain activity causing these components to appear in EEG. The sources were located in hand representation areas of the primary sensorimotor cortex. Their positions practically coincide with the regions of brain activity during the motor imagination obtained in fMRI study. Individual geometry of brain and its covers provided by anatomical MR images was taken into account when localizing the sources.