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HighlightsInteractive therapy (stimulation) of the brain has a significant potential, especially if it includes not only medical, but neurophysiological and psychological modalities. An integrated approach is required to provide complete readaptation to new life conditions and to decrease the percentage of disabilities in post-stroke patients. Abstract:Aim. The article is devoted to the psychological support in neurorehabilitation of patients with acute disorders of cerebral circulation. Interactive therapy (stimulation) of the brain is a new generation of neurofeedback characterized by a radical change in the “targets” of cognitive (adaptive, volitional) influence. These targets are specific cerebral structures and neural networks, the reconstruction of which leads to the restoration of physiological functions and behavioral (psychological) metamorphoses.Methods. The study involved 18 patients diagnosed with ischemic stroke with hemiparesis of 2 points in the hand (early recovery period). All patients received rehabilitation treatment at the clinic of the Federal Research Center for Fundamental and Translational Medicine. The rehabilitation program for patients from the main group (n = 11) was supplemented with a course of interactive brain stimulation in an MRI scanner. Functional magnetic resonance imaging (fMRI) in the biofeedback contour uses a natural intravascular tracer, a blood oxygen level dependent (BOLD) signal, as feedback. Thus, the subject included into an “interactive brain” circuit is learning to modulate and modify his cerebral networks creating the new ones, or “awakening” pre-existing ones in order to improve (or reform) his mental, sensory and/or motor functions. The subject being placed in a tomograph for a long time to learn new reparative skills is in a significant need of constant (sustainable) psychological support at all stages of the neurorehabilitation.Results. A course of interactive therapy contributed to a radical improvement in motor functions, confidence in movements, and an increase in working capacity. The analysis of fMRI data over time showed that activation of the accessory motor cortex and cerebellum on the ipsilateral side at the beginning is replaced by bilateral expansion of activity zones in the cerebellum and premotor cortex by the end of the course of interactive therapy. It also was established that the result of a stroke is a deep transformation of the intrapersonal relationships of patients. At the same time, rehabilitation has significant potential, especially if it includes not only medical, but also neurophysiological and psychological modalities. The dynamics of learning in terms of fMRI mapping should be successfully synchronized with the kinetics of psychological metrics and success scales, the influence of which, as a rule, remains beyond the scope of clinical studies.Conclusion. This study was carried out in line with the search for a self-referential psychological accompaniment that optimizes the recovery, the study of temporal and spatial correspondence between the interactive dynamics of fMRI and specific clinical symptoms.
HighlightsInteractive therapy (stimulation) of the brain has a significant potential, especially if it includes not only medical, but neurophysiological and psychological modalities. An integrated approach is required to provide complete readaptation to new life conditions and to decrease the percentage of disabilities in post-stroke patients. Abstract:Aim. The article is devoted to the psychological support in neurorehabilitation of patients with acute disorders of cerebral circulation. Interactive therapy (stimulation) of the brain is a new generation of neurofeedback characterized by a radical change in the “targets” of cognitive (adaptive, volitional) influence. These targets are specific cerebral structures and neural networks, the reconstruction of which leads to the restoration of physiological functions and behavioral (psychological) metamorphoses.Methods. The study involved 18 patients diagnosed with ischemic stroke with hemiparesis of 2 points in the hand (early recovery period). All patients received rehabilitation treatment at the clinic of the Federal Research Center for Fundamental and Translational Medicine. The rehabilitation program for patients from the main group (n = 11) was supplemented with a course of interactive brain stimulation in an MRI scanner. Functional magnetic resonance imaging (fMRI) in the biofeedback contour uses a natural intravascular tracer, a blood oxygen level dependent (BOLD) signal, as feedback. Thus, the subject included into an “interactive brain” circuit is learning to modulate and modify his cerebral networks creating the new ones, or “awakening” pre-existing ones in order to improve (or reform) his mental, sensory and/or motor functions. The subject being placed in a tomograph for a long time to learn new reparative skills is in a significant need of constant (sustainable) psychological support at all stages of the neurorehabilitation.Results. A course of interactive therapy contributed to a radical improvement in motor functions, confidence in movements, and an increase in working capacity. The analysis of fMRI data over time showed that activation of the accessory motor cortex and cerebellum on the ipsilateral side at the beginning is replaced by bilateral expansion of activity zones in the cerebellum and premotor cortex by the end of the course of interactive therapy. It also was established that the result of a stroke is a deep transformation of the intrapersonal relationships of patients. At the same time, rehabilitation has significant potential, especially if it includes not only medical, but also neurophysiological and psychological modalities. The dynamics of learning in terms of fMRI mapping should be successfully synchronized with the kinetics of psychological metrics and success scales, the influence of which, as a rule, remains beyond the scope of clinical studies.Conclusion. This study was carried out in line with the search for a self-referential psychological accompaniment that optimizes the recovery, the study of temporal and spatial correspondence between the interactive dynamics of fMRI and specific clinical symptoms.
The importance of post-stroke rehabilitation cannot be overestimated. The aim of this study was to assess the effectiveness of a standardized post-stroke rehabilitation program for patients with moderate impairments. A total of 122 stroke survivors participated in the study. Group 1 (the comparison group) consisted of 59 patients undergoing standard rehabilitation. Group 2 (the main group) consisted of 63 patients participating in a specially designed social rehabilitation program. The functional, cognitive, psychological and emotional states and the level of social activity were monitored for 6 months. Group 2 demonstrated more pronounced improvement than group 1 after 6 months of follow-up, confirmed by higher Rivermead (p = 0.011) and SS-QOL (p < 0.05) scores and lower DASH and Beck scores (p = 0.015 and p < 0.001, respectively). In both groups, MMSE (cognitive function) scores slightly increased, but the differences between the groups were insignificant. The proposed post-stroke rehabilitation program is effective in helping patients regain their independence and improve social adaptation. The scales and scores used in the study, especially DASH and SS-QOL, are sensitive to changes in the functional state of stroke survivors with moderate impairments.
The aim of the study — to establish the severity of cognitive, psychoemotional, motivational and behavioral disorders in patients after acute period of ischemic stroke.Materials and methods. The study included 60 patients with a diagnosis of ischemic stroke. Depending on severity of neurological deficit according to the national stroke scale (NIHSS), patients were divided into two groups: group 1 — 30 patients with an NIHSS score of 0 to 8, associated with mild neurological deficit, group 2 — 30 patients with an NIHSS score of 9 to 15, associated with moderate neurological deficits. The study was conducted on the 7th day of treatment and included: assessment of the cognitive status according to the Montreal Cognitive Assessment scale; assessment of the level of distress, depression, anxiety and somatization using the Four Dimensional Symptom Questionnaire; assessment of mental and physical asthenia according to the MFI-20 scale, level of self-control using the Rotter’s Locus of Control Scale and assessment of the personality and the familial unconscious in Szondi’s test. Results. The study established the prevalence of depression and cognitive impairment in patients with moderate neurological deficits. Patients with mild neurological deficits are characterized by a moderate level of somatization, mental and physical asthenia, a low level of self-control in relation to health, low adherence to treatment and poor motivation to recover.Conclusion. The results of the study indicate the need inclusion of assessment of psychoemotional factors and personal resources of the patient in relation to illness and recovery in early diagnosis of patients with stroke. Along with neurological deficits, it is necessary to assess the cognitive, emotional and motivational levels of the “internal picture of the disease”. This can help determine the patient’s basic compensatory and adaptive capabilities and develop individual rehabilitation strategies.
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