RU2428927C2 - Method of psychophysiological state normalisation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: signals of patient's brain are registered, sensor signals corresponding to brain signals are formed and used to influence patient. Each sensor signal is formed in accordance with parameters of each fluctuation of brain signal, rates of sensor signal increase and decrease are set such, at which induced brain activity is not detected by registering equipment.

EFFECT: method makes it possible to increase efficiency of processes of psychophysiological state and organism's cognitive functions normalisation due to setting mode of rate of sensor signal increase and decrease.

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Description

The invention relates to medicine, namely to non-drug methods of normalizing the psychophysiological state of the body, and can be used during stressful periods, psycho-emotional and intellectual stress, as well as in the treatment of functional disorders of the central nervous system, psychosomatic diseases and the effects of organic brain damage.

Currently, there is an increasing interest in non-drug methods of rehabilitation of patients with various types of pathologies. One of the rapidly developing areas of non-pharmacological correction of the psychophysiological state of the body are neurotherapy methods. These methods use various methods of influencing the body, including acoustic, visual, tactile, as well as temperature signals. During neurotherapy, the patient is exposed to sensory signals of various modalities in both direct stimulation and biofeedback modes.

A known method of correcting the functional state of neurological patients, based on the use of feedback signals from the bioelectrical activity of the patient’s brain (G. Dzhunusova, R. A. Kurmashev, Use of adaptive EEG biocontrol for correcting the functional state of neurological patients. Human Physiology, 2002, Volume 28 No. 1, pp. 18-22). This method organizes visual feedback on the alpha, beta, theta and delta rhythms of the electroencephalogram (EEG). As a feedback feedback signal, light signals of four colors are used, which are turned on in accordance with the appearance in the current EEG of an oscillation belonging to one of the four rhythms. When the alpha rhythm fluctuates, the green light turns on, when the beta rhythm fluctuates, it turns yellow, when the theta rhythm fluctuates, it turns orange, and when the delta rhythm fluctuates, it turns red. Registration of EEG is carried out in the frontal, temporal, parietal and occipital areas of the left and right hemispheres of the brain. The patient is asked to find a condition in which the color indicated by the doctor-operator appears as often as possible. As a result of such treatment procedures, a positive dynamics of the patient's condition is observed.

This method has a significant drawback, significantly weakening the effectiveness of medical procedures. In this method, it is assumed that the light signals are instantly turned on after the appearance of a corresponding oscillation of the brain signal. This dynamic stimulus presentation mode is used to produce evoked brain activity. Therefore, this method of presenting sensory signals will have a significant impact on the current brain function, in which not only its own, but also the induced activity will be recorded, while the task of the feedback channel is to transmit information about the brain’s own activity.

The closest to the proposed invention in technical essence and the achieved result is the invention "Method of bioacoustic correction of the psychophysiological state of the body" according to the patent of the Russian Federation No. 2192777. In accordance with this method, EEG is recorded from two or more EEG removal points, a one-to-one correspondence is established between the spatial location of the EEG registration points and sound sources, each EEG oscillation is transposed separately and sequentially into the audio frequency range, and the patient is simultaneously exposed to the received sound signals.

This method, selected as the prototype of the present invention, allows, in comparison with other known methods, to increase the accuracy of transmitting information about the current state of the central nervous system in the feedback loop by transposing the sequence of the initial EEG oscillations into the region of audible frequencies and reflecting the spatial parameters of the EEG in the sensor signal.

The disadvantage of this method is that it does not take into account the rate of rise and fall of sound stimuli, that is, it is assumed that they appear instantly after the oscillation of the brain signal occurs.

It is known that brain signals, in particular EEG, which are the result of activity of nerve tissue, are composed of two components: intrinsic or background, and evoked activity of nerve cells (Gasanov UG Systemic activity of cortical neurons during training. M., Science, 1981 ) The first component is determined by the internal events of the body, while the induced activity is determined by external environmental events. The objective of the feedback channel is to transmit information about the state of the body. Therefore, in the feedback signal, first of all, information on the brain's own activity should be displayed. Thus, sensory stimuli reflecting EEG parameters should not provoke induced activity. It is known that an increase in the rise time of the sensory signal leads to a decrease in the amplitude of the evoked responses of the brain, i.e., the gradient of the sensory signal is directly proportional to the amplitude of the evoked response of the brain (Altman, Ya.A. Hearing System. L., Nauka, 1990). It follows that the instantaneous supply of a sensor signal will lead to the appearance of evoked activity and, consequently, to a distortion of information about the brain’s own activity. The instantaneous rise and fall of sensory signals is a common disadvantage of known methods for organizing biofeedback. This disadvantage limits the effectiveness of these methods.

The aim of the creation of the present invention is to increase the efficiency of the processes of normalizing the psychophysiological state of the body with its functional disorders, psychosomatic diseases and organic lesions of the central nervous system.

This goal is achieved by the fact that in the method of normalizing the psychophysiological state, the following actions are sequentially performed: the patient’s brain signals are recorded, sensory signals corresponding to the brain signals are generated and these signals are applied to the patient. Moreover, each sensor signal is formed in accordance with the parameters of each oscillation of the brain signal, and the rise and fall rates of the sensor signal are set such that the evoked brain activity is not detected by the recording equipment. Thus, in this method, the patient is exposed to sensory signals that reflect the work of his brain. The peculiarity of exposure to sensory signals is that sensory signals should not lead to the appearance of evoked brain activity. This is achieved by the fact that the rise and fall rates of the sensory signal are chosen to be significantly lower than in standard methods for producing evoked potentials (V.V. Gnezditsky. Evoked brain potentials in clinical practice. M., MEDpress-inform, 2003). Fulfillment of this requirement allows one to more accurately reflect the brain's own activity in sensory signals rather than the induced one. As sensory signals, a separate sound, light or tactile effect is used. It is also possible to use any complex combination of sound, light and tactile effects as sensory signals.

The method allows to increase the efficiency of the processes of normalizing the psychophysiological state of the body with functional disorders and organic lesions of the central nervous system.

A comparative analysis of the prototype and the proposed method shows that the differences of the latter lie in the method of formation of the sensor signal and, therefore, the proposed method meets the criterion of "novelty."

Comparison of the proposed method with other technical solutions known in the art allows us to conclude that it follows from them in an unobvious manner and, therefore, meets the criterion of "inventive step".

The compliance of the proposed method with the criterion of "industrial applicability" is confirmed by the implementation of the method in the device of medical equipment.

The device comprises sensors of the patient’s brain signals, a block for registering brain signals, a unit for converting selected brain signals into corresponding sensory signals, a block for exposing the patient to sensory signals, and a control unit for the parameters of the brain signals and a sensor signals control unit.

During the treatment procedure, the patient’s brain signals are recorded by the brain signal registration unit; in the control unit for the patient’s brain signal parameters, the patient’s psychophysiological state is evaluated using the brain signals. At the same time, in the unit for converting the selected parameters of the brain signals into sensory signals, the selected parameters of the patient's brain signals recorded by the sensors are converted into the corresponding sensory signals. Using the patient exposure unit with sensor signals, the patient is affected by the generated sensor signals. The sensor signals control unit sets the permissible rates of rise and fall of each sensor signal at which the induced brain activity is not detected, and also sets the duration of the treatment procedure.

In GUZ MUCH No. 18 (St. Petersburg), on the basis of the neurorehabilitation department, the results of studies of the application of the proposed method in the treatment of patients with the effects of organic brain lesions of varying severity were obtained (examination protocols from 04/22/2008 to 06/06/2008, No. 3310- 470). During treatment, from 13 to 18 sessions were conducted with each patient, during which the patient's brain signals were recorded, the selected parameters of the brain signals were converted into the corresponding sensory signals, and they acted on the patient. In this case, the rates of rise and fall of the sensory signal were set such that the evoked brain activity was not detected. On average, the duration of the exposure session was 15-20 minutes. During the course of procedures, normalization of the psychophysiological state and cognitive abilities of patients was noted, which was expressed in a significant decrease in the level of reactive and personal anxiety using the Spilberger-Khanin test, normalization of cognitive functions using the Mini Mental State Exemination test, and a decrease in the level of depression according to the TID test (anxiety and depression) , a decrease in the number of errors and a decrease in the reaction time in visual and acoustic sensorimotor tests, an increase in the alpha rhythm index, a decrease in the beta rhythm index, and a decrease in the level of I hemispheric asymmetry.

We also examined 17 male adolescents (15-17 years old) with the debut of sluggish schizophrenia (psychopathic neurosis-like form) who were in-patient treatment in the city psychiatric hospital No. 3 named after Skvortsova-Stepanova (St. Petersburg) at the adolescent department (examination protocols from 1.02.2008 to 04.20.2008, No. 10-173). The diagnosis was made on the basis of psychological, psychiatric and neurological examination. In addition, the expert’s conclusion about the absence of signs of convulsive brain activity in the clinical electroencephalogram (EEG) was taken into account. All patients underwent a course of functional treatment using procedures including sequential recording of the patient’s brain signals, converting the selected parameters of the brain signals to the corresponding sensory signals, and exposing the patient to these sensory signals, while the rise and fall rates of each sensory signal were set such that brain activity was not detected.

The procedures consisted in listening to patients in real time of sensory signals in the form of an acoustic image of their own EEG. The EEG was recorded on 4 channels at points Fp1, Fp2, 01, and 02, unipolar to the combined ear electrodes with a sampling frequency of 250 Hz. An acoustic image was created on the basis of the recorded EEG by establishing the correspondence of the parameters of the brain bioelectric activity to the parameters of acoustic signals. Real-time acoustic signals were presented to the patient.

During the session, the patient was only asked to "listen to the work of his own brain." During the procedure, the patient's eyes were closed. For each of them, a comfortable volume level was set. Each procedure included the following: registration of EEG in silence with eyes closed (1 min), LHC session (15-20 min), registration of EEG in silence with eyes closed (1 min). The course of treatment consisted of 7-10 procedures.

Efficiency control was a comparison of the results of treatment of patients with the results of observations of healthy adolescents of the same age obtained earlier. All adolescents underwent a preliminary examination by specialists, a neurophysiological and psychological examination before and after each session, as well as at the end of the LHC course. The examination included EEG analysis, SAN, Spielberger-Hanin, Zung tests,

When studying the bioelectric activity of the brain on the basis of periodometric analysis, the average value of the fraction of the periods of EEG oscillations of the alpha, beta, theta and delta ranges for the entire session was calculated, and the level of interhemispheric asymmetry of the EEG periodograms of the frontal and occipital leads was estimated.

Statistical analysis was performed using the STATISTIKA software package. The reliability score was calculated by t-student test.

The examination carried out before the start of treatment revealed the preservation of consciousness in patients, the absence of delusions and deceptions of perception, the correct orientation in place, time, and self. Teenagers complained of a bad mood, difficult relationships with family, especially with their mother, fears and nightmares. They were emotionally unstable, conflicting, vulnerable to criticism. The behavior pattern in adolescents with depressive syndrome was based on a sense of persistent anxiety, a decrease in the emotional, mental, and volitional sphere with relatively safe intelligence. They acutely experienced a sudden feeling of loneliness, their own inferiority, focusing on individual facial features, body parts, their growth (delirium of dysmorphophobia). Patients themselves could not solve the problem of their experiences. They did not have a desire to continue work, study. The existing disorders led to the development of destructive behavior - “learned helplessness”, alcohol and drug addiction, suicides. When assessing the psychophysiological status using the Spilberger-Khanin test, they found moderate reactive (36-40 points) and high personal (44-58 points) anxiety. The level of depression was 41-53 units. on the Zung scale. According to the SAN test, there was an underestimated self-esteem of one’s condition, and increased fatigue. The subjective time estimate (1 min) was 25-30 sec (normal 40-50 sec).

According to the analysis of the EEG at the beginning of treatment according to the claimed method, a significant severity of the proportion of the delta rhythm (up to 28%) and theta rhythm (up to 40%) was noted in the frontal leads. Alpha rhythm index up to 52% in the occipital lead and up to 35% in the frontal lead. In the EEG pattern in all patients, a distortion of alpha spindles by slow-wave oscillations of the theta and delta ranges was revealed. The intensity of the beta rhythm in the frontal leads reached 28%. There was also pronounced interhemispheric asymmetry (the amplitude of the bioelectrical activity of the brain was reduced more in the left hemisphere), especially in the front parts of the brain, which is consistent with the concept of left hemisphere dysfunction in schizophrenia). Cross-correlation analysis showed a significantly reduced relationship between the frontal and occipital leads, more to the left. With functional loads - rhythmic photostimulation caused the assimilation of individual frequencies and increased paroxysmal manifestations, hyperventilation increased slow activity. A delay in the formation of regional differences in terms of spatial synchronization was identified. The results indicate a decrease in the level of activation of the cortex and a decrease in the wakefulness reaction (thalamo-cortical dysregulation). Existing affective disorders (anxiety, fear, depression) are caused by a deficit of positive motivation caused by a violation in the control system of mesocorticolymbic brain structures. Violations in the field of emotional reinforcement led to a mismatch in the systemic mechanisms of central nervous system regulation (attention, memory, intelligence, behavior), and to the development of a schizophrenic defect. Dysfunction of the thalamocortical structures led to impaired cognitive function.

In the process of carrying out the procedures in accordance with the claimed method, a restructuring of the bioelectric activity of the brain of patients was revealed. It was shown that the average value of delta activity in 8 people at points Fp1, Fp2 decreased from 15.3 ± 4.4 to 12.2 ± 3.1% (p <0.05). In the occipital leads, delta activity decreased from 4.6 ± 2.5 to 2.9 ± 1.3% (p <0.01). In the alpha rhythm range, a significant increase in intensity was found in the occipital leads from 56.6 ± 11.0 to 64.0 ± 12.2% (p <0.05). A significant decrease in beta activity was recorded in the occipital leads from 20.7 ± 9.0 to 15.6 ± 7.8% (p <0.05) and in the frontal leads from 29.97 ± 9.5 to 23.0 ± 7.7% (p <0.01). In the theta rhythm region in the frontal leads, an increase in intensity was noted from 23.4. ± 4.2 to 26.6. ± 4.6% (p <0.02), in the occipital leads a decrease from 17.2 ± 5.6 up to 14.2. ± 3.8% (p <0.05). The level of interhemispheric asymmetry of brain BEA, estimated by the difference in EEG periodograms on the right and on the left, decreased from 17.4 ± 4.8 to 11.2 ± 1.3% in the frontal regions and from 24.5 ± 14 to 18.7 ± 8. 4% in the occipital regions of the brain.

Thus, as a result of treatment in accordance with the claimed method, a clear functional normalization of the EEG pattern was observed: an increase in the alpha rhythm power, a decrease in theta and delta activity. When analyzing the attention function, a shortening of the latent period of the sensorimotor reaction to visual words from 457 ± 103 to 403 ± 55 ms at 15 and 3% errors, respectively, and to a double tone from 498 ± 67 to 410 ± 60 ms at 15 and 3% errors, respectively, were found. The positive dynamics in the analysis of cognitive processes was also confirmed in the results of changes in the state of patients and according to clinical observations. Patients significantly improved their well-being, mood, increased self-esteem, decreased anxiety level, and improved sleep. There was criticism of his behavior. In general, the procedures for listening to your own EEG sound image contributed to the positive transformation of the psychoemotional state of patients.

Thus, it was found that in adolescents with depressive schizophrenia syndrome, the application of the procedures of the present method proved to be the most effective and physiologically adequate means of psychotherapeutic intervention. After a course of procedures, a stable psychological defense skill was developed in patients, as a result of which the level of anxiety decreased, and the depressive syndrome stopped.

As an additional illustration of the effectiveness of the proposed method, we give an example of a patient with a debut of schizophrenia with depressive syndrome: patient Ness-in S.O., 16 years old (01.03.2008-10.04.2008). A native of St. Petersburg, heredity is burdened by schizophrenia from the side of the mother's uncle, alcohol dependence. The condition was characterized by low mood, tension, anxiety, apathy, emotional smoothness, monotony and lack of adequacy of affective reactions. No suicidal tendencies were observed. Arbitrary direct memory is weakened. Indirect - within normal limits. Caution - Organic Depleted. The general rate of mental activity is slowed down. In thinking, signs of structural disturbances were revealed that affected its operational component in the form of a distortion of generalization processes with periodic reliance on distant and latent signs of concepts in the implementation of comparison operations. A dynamic component in the form of instability of the level of generalizations when performing tasks and operations of equal complexity. The motivational component of thinking in the form of fuzzy judgments, diversity, purposefulness disorders. The criticality of thinking is broken. According to the results of a survey by the Wexler method, intellectual development corresponded to the level of a low norm (general IQ = 86, verbal intelligence 92, nonverbal 79), which is typical for organic disorders. The emotional sphere was characterized by low differentiation, poverty and the uniformity of affective reactions. Utilitarian-hedonistic motives dominated the hierarchical structure of needs. I had no hobbies. He led a passive lifestyle. The motive function of motives is weakened. Decreased the processes of goal setting and goal achievement. By nature, closed, anxious, passive, somewhat impulsive. He is characterized by high individuality, social maladaptation, a schizoid type of response. He didn’t aspire to communicate, had no friends. He was characterized by reactions of avoidance, withdrawal into himself and a manifestation of compliance. In the event of an increase in psychoemotional tension, he was inclined to commit impulsive-aggressive actions directed at himself or others without criticizing the consequences of his behavior. Thus, individual psychological characteristics were characteristic, such as a structural violation of thinking, a violation of criticality, a decrease in the emotional and volitional sphere, lethargy, as well as a decrease in energy potential. There was also a distortion of the hierarchical structure of needs, a weakening of the motive function of motives, corresponding to a schizophrenic pathopsychological symptom complex. Impairment of thinking was combined with signs characteristic of organic disorders, such as exhaustion of voluntary attention, a significant decrease in non-verbal intelligence in relation to verbal, and general torpidity, reflected in psychomotor. Diagnosis: schizophrenia - a paranoid form, an organic personality disorder and behavior, suicidal behavior. The alpha rhythm (70%), correctly distributed, dominates in the EEG. Spindles are weakly expressed. In the frontal leads, the severity of the delta rhythm is significant: the proportion of periods of delta range oscillation is 13%.

After the complex therapy with the procedures in accordance with the claimed method according to the clinical observations, the patient significantly improved health, mood, and recovered sleep. Behavior has changed: delusional symptoms have faded, self-esteem has increased, criticism for one’s behavior and others has appeared, sociability has noticeably improved, the level of anxiety and aggressive behavior has decreased. The alpha rhythm (70%), correctly distributed, began to dominate in the EEG. Spindles are well defined. The delta activity in the frontal leads decreased to 8–9%.

Discharged with a clear improvement on maintenance therapy and observation in a neuropsychiatric dispensary at the place of residence. Thus, the above examples of the implementation of the proposed method of normalizing the psychophysiological state show that its use in comparison with the prototype allows you to more effectively restore the psychophysiological state of patients by sequentially registering the brain signals of the patient, converting the selected parameters of the brain signals to the corresponding sensory signals and exposure of the patient to these sensory signals, and at the same time establish such rates of rise and fall each of the sensor signal at which the induced brain activity is not detected.

The proposed method of normalizing the psychophysiological state of patients can be widely used in medical and rehabilitation institutions of various fields, including hospitals, clinics, sanatoriums, rest homes, hotels.

Claims (3)

1. A method of normalizing the psychophysiological state, including sequentially registering the patient’s brain signals, converting the selected parameters of the brain signals to the corresponding sensory signals, and exposing the patient to these sensory signals, characterized in that such rates of rise and fall of each sensory signal are established at which the induced activity brain is not detected. 2. The method according to claim 1, characterized in that the sound signals, light or tactile effect are used separately as sensory signals. 3. The method according to claim 1, characterized in that any complex combination of sound, light and tactile effects is used as sensory signals.