RU2798703C1 - Method of social adaptation of patients with cognitive and speech disorders - Google Patents

Abstract

FIELD: medicine; diagnostics; neurology; rehabilitation.

SUBSTANCE: speech, cognitive and movement disorders are assessed. Their dynamics is tracked. Management of the rehabilitation process is carried out in a hardware-software complex, which includes software, an electroencephalograph (EEG), virtual reality glasses (VR), a stereo camera located opposite the person being rehabilitated, and a computer. The patient is shown a social scene in VR. The correctness of the performance of task on motor interaction with virtual objects is assessed by registering the semantic potential N400 in the range of 350–450 ms. Next, the patient hears a sound signal corresponding to the operation of the BP object. The registration of the average latent potential N1 with a latency of 85–95 ms corresponds to the fact of sound registration by the auditory system. Further, the target object, with which the interaction is to be, begins to change its illumination or deviant sounds appear, corresponding to its work. Registration at the same time of the cognitive evoked potential P300 to visual and auditory target stimuli with a latency in the range of 250–350 ms confirms the patient's ability to focus on the target virtual object. Next, the patient performs an imitation of motor contact with the object, the success of which is visualized based on the data received from the stereo camera.

EFFECT: method allows obtaining objective data on speech, cognitive and motor disorders, assessing the dynamics of these disorders and managing the process of social rehabilitation by collecting and analyzing data from the EEG device and stereo camera, and also provides an expansion of the arsenal of means for managing the rehabilitation of patients.

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Description

The invention relates to medicine, namely to diagnostics, neurology and rehabilitation. They receive data about the subject, which are an objective reflection of his speech, cognitive and motor impairments, and also allow assessing the dynamics of these disorders and ensuring the management of the social rehabilitation process, by collecting and analyzing data from the EEG device and stereo camera. The invention is implemented in a hardware-software complex, which includes software for launching and conducting a procedure using virtual reality (BP) technologies for the social rehabilitation of patients with speech (afferent and semantic aphasia) and cognitive impairments of mild and moderate severity , based on semantic, cognitive and motor interaction with BP objects, created as part of the program of activities of the leading research center "Social adaptation of patients with neurological diseases using virtual reality technologies and hand motion capture of the Samara State Medical University of the Ministry of Health of Russia.

From the prior art there is a method for evaluating the effectiveness of the therapy of cognitive disorders at the stage of rehabilitation in patients with vibration disease patent RU No. 2457779 with priority from 01/12/2010. EEG registration is carried out and a study of the spectral power of the delta range before and after treatment is performed. The absolute values of the power of the δ1-rhythm and δ2-rhythm are analyzed in the frontal leads of both hemispheres of the brain. With a decrease in the absolute values of the power of the 51-rhythm in the right leads by more than 37%, and in the left leads by more than 44% and the δ2-rhythm in the left leads by more than 70%, compared with these indicators before treatment, the ongoing therapy is evaluated as effective. This method only evaluates the activity of the functioning of the cerebral cortex, but not the evoked potentials that correspond to cognitive and speech functions.

Also known is a method of teaching children with autism spectrum disorders of varying severity using a model of a polysensory virtual-real learning space, patent RU No. 2722673 with a priority of 01.10.2019. Children with autism spectrum disorders with an established diagnosis with degrees of severity: F84.0, F84.1, F84.5, F84.8, taking into account the age, health characteristics and level of development of the child, the teacher at the first stage immerses him in the virtual space using a hardware-software complex to perform tasks on a computer and controls the program with a remote control, fixes the result while being out of sight of the child, who is in front of the computer screen, using the keyboard, mouse, foot pedals, joystick and microphone, performs tasks on the computer that he receives from the virtual character. By the reaction of the character, the child understands whether he coped with the task. The invention provides for the creation of a polysensory virtual-real learning space that facilitates the learning process for children with autism spectrum disorders of varying severity by gradually transferring the child's skills to the real space and increasing his interest in real life, improving his general emotional state. This method improves adaptation, however, the assessment of actions is limited to motor responses without control of cognitive and language responses caused by potentials.

There is a known method for the rehabilitation of patients with post-stroke disorders patent RU No. 2688723 with priority from 05/25/2018. Classes are carried out on a hand exoskeleton controlled by the brain-computer interface, 3 training cycles per day for 10 minutes each cycle. On the monitor screen, a mental task is set for the imagination of opening the right and left hands and the process of relaxation. To do this, in the center of the monitor there is a circle for concentration and 3 arrows that represent the right and left hands and rest. When imagining movements, the hands should remain motionless. The skill of kinesthetic imagination of the movement of the hand is fixed in classes with a speech therapist, in which the patient pronounces an assessment of his actions in dynamics, choosing words, forming phrases to characterize his actions. After that, training is carried out on a stabilometric platform with biofeedback for 3-5 minutes, using the visual and auditory channels in the training process, for which the patient, being on the stabilometric platform in front of the monitor and moving his body relative to the feet, must combine his center of pressure ( CSD), shown to him on the screen in the form of a cursor with a target, holding the CSD in the center of the target or moving it. Then, continuing classes on the stabilometric platform, they simultaneously conduct classes with a speech therapist, in which the patient first comments on the actions he performs on the stabilometric platform for 3-5 minutes, and then the same lesson is continued in a question-answer form for 7-10 minutes. After that, vibration therapy is prescribed at a frequency of 10-100 Hz for 10-15 minutes, in the form of alternating vibration therapy of arms and legs every other day. After 1-2 hours, cognitive training is carried out using computer programs or desktop visual material in the form of solving problems on counting, memory, constructive-spatial thinking, attention, for 15-30 minutes. Neurorehabilitation occurs due to the potentiating effect of processes occurring in the brain during complex multimodal stimulation, which reduces cognitive and motor deficits, and reduces the duration of rehabilitation treatment. The main disadvantage of this method is the complexity of implementation and the need to use a large amount of equipment and personnel, which leads to an increase in the cost and complexity of the rehabilitation process. Another disadvantage is the inability to control the rehabilitation process due to objective biological signals of the functioning of the brain.

Closest to the claimed invention is a method for the rehabilitation of patients using a virtual environment patent RU No. 2654767 with priority from 12/02/2016. In a virtual environment, situations are created that require the patient to make decisions on how to get out of them with maximum concentration on achieving the goal. At the same time, the patient is required to concentrate locally on a virtual moving object. At the same time, throughout the entire rehabilitation session, the patient's condition is monitored by electrical activity of the brain, myogram, measurement of heart rate with the possibility of updating the created situation based on the results of the control. Before the session and after its completion, the state of the patient's visual system is monitored by measuring its temporal and spatial-frequency-contrast characteristics with the possibility of selecting a band of spatial and temporal frequencies in the virtual environment to compensate for violations of the patient's contrast sensitivity. In this method, an EEG is performed during rehabilitation and the patient is monitored, however, there is no possibility, as in the claimed method, to expand the use of EEG in terms of using the activity of reactions and managing the rehabilitation process.

The technical result of the claimed method of social adaptation of patients with cognitive and speech disorders is the expansion of the arsenal of tools that provide management of rehabilitation, namely the change of rehabilitation tasks, determining its duration and type, based on objective methods of recorded physiological parameters obtained by registering EEG and various types evoked potentials after its averaging, as well as a stereo camera that allows you to control the performed motor act of the rehabilitation session, providing information for the operation of the motion visualization algorithm, which is demonstrated to the rehabilitated person using virtual reality (BP) technology.

The claimed technical result is achieved due to the target interaction of the patient with the object, which determines the semantic sequence of this interaction based on the analysis of EEG activity and registration based on it cognitive (P300, with a latency in the range of 250-350 ms, against the background of a deviant visual or auditory stimulus) or linguistic (semantic) evoked potential (N400, in the range of 350-450 ms.), as well as mid-latent auditory evoked potentials (N1, with a latency of 85-95 ms), arising in response to repeated instructions for the person being rehabilitated, sounding in a virtual environment. This number of evoked potentials provides the possibility of using the method for various types of aphasia (afferent, semantic) and the degree of cognitive impairment from mild to moderate. A correctly understood verbal instruction, based on objective control of registered evoked potentials, must be completed with an imitation of an interaction rehabilitated with a virtual object, which will be controlled using a stereo camera.

This method does not imply a quick interaction with virtual reality objects, because requires the need to obtain registration of evoked potentials for successful completion of tasks, which is associated with a certain amount of presentation of target stimuli against the background of non-target ones, going in a ratio of 1:3 for cognitive and semantic (linguistic) evoked potential. The minimum number of target stimuli should be 10. The cognitive evoked potential for a visual stimulus is generated by changing the illumination of a displayed household object, the duration of this illumination is 100 ms, the flicker frequency is 5 Hz. The cognitive evoked potential for an auditory stimulus is generated upon presentation of a deviant stimulus in the frequency range of 1000-2000 Hz, the choice of which can be made on the basis of the maximum correspondence to the sound frequency corresponding to the demonstrated household environment (for example, the sound of a boiling kettle), with a frequency of 1 Hz, a signal duration of 100 ms. The condition for obtaining a semantic (linguistic) evoked potential is a short statement consisting of three words, an instruction that sounds in the semantic context of the virtual environment being demonstrated. The deviant stimulus in this presentation will be the presence of a semantically inappropriate word in this instruction. For average latent auditory evoked potentials, it is necessary to receive at least 100 stimuli presented with a frequency of 5-200 Hz, the duration of each stimulus is 0.1-1 ms.

The sequence of semantic interaction with virtual objects in a virtual environment that dismantles the social scene (kitchen: cooking; public transport: fare payment, getting off at a certain stop; shop: buying and paying for goods at the checkout, etc.) is determined by the registration of various types evoked potentials and, when registering them, should be supported by the execution directly by the movement of the upper limb.

At the beginning of rehabilitation, the patient may be given an oral or written instruction about the need to perform one or another action in the environment demonstrated by BP. At the beginning of rehabilitation, the patient hears a sound signal corresponding to the work of one or another BP object, and the average latent potential N1 is registered. Its registration corresponds to the fact of sound registration by the auditory system. In the future, the target object with which the interaction is to begin to change the illumination or deviant sounds appear corresponding to its work. There is a registration of the cognitive evoked potential P300 to visual and auditory target stimuli. P300 registration confirms the ability of the person being rehabilitated to focus on the target virtual object and make this choice consciously, overcoming cognitive and speech impairments. When registering this signal, the person being rehabilitated will have to imitate motor contact with this object, the success of which is visualized based on the data received from the stereo camera. This process can be repeated many times for a variety of virtual reality objects, the sequence of interaction with which is determined by the semantics of the general task.

The highest-level interaction with virtual objects will be based on the registration of the evoked potential N400, which occurs in response to a semantically incorrect verbal instruction, which will be a condition for the correct execution of the task of motor interaction with virtual objects by observing the semantic sequence. The registration of this evoked potential is the rationale for objectifying the understanding of the verbal instruction by the rehabilitated, which is a necessary condition for the rehabilitation of semantic aphasia and cognitive impairment of moderate severity.

The method is implemented by using an interconnected electroencephalograph [1] for recording scalp electroencephalographic activity via 21 channels, installed on the patient's head in accordance with the "10-20" system, reference electrodes are installed in the M1 and M2 projections (mastoid processes); virtual reality glasses [2] to provide a demonstration of various social scenes, the objects of which the patient will have to interact with during rehabilitation sessions (for example, a kitchen virtual scene with the cooking process) [3]; a stereo camera located opposite the person being rehabilitated to ensure the capture of movements of the arms and the hand itself in order to visualize and determine the correctness of interaction with virtual reality objects [4], a computer through which the virtual scene is controlled, data collection and analysis (obtaining evoked potentials) coming from the EEG of the device [ 5] Fig 1.

The implementation of the claimed method of social adaptation of patients with cognitive and speech disorders is reflected in a clinical example.

Patient K., 64 years old. He was admitted to the rehabilitation department on February 17, 2021 with a diagnosis of atherosclerosis of cerebral vessels. Acute cerebrovascular accident. Ischemic stroke in the basin of the left MCA. dated December 10, 2021, an early rehabilitation period. Moderate right-sided central hemiparesis. Elements of sematic aphasia” The patient was admitted to a rehabilitation center for a course of classes to reduce the severity of motor and speech disorders. A neurological, speech therapy examination was carried out, as well as testing on cognitive, motor jackals to control the effectiveness of the rehabilitation performed. According to the neurological examination, the patient has central paresis of the facial nerve on the right, of mild severity, right-sided asymmetric central paresis of the limbs with a predominant lesion of the upper limb. According to a six-point scale for assessing muscle strength in the right hand, the strength in the proximal sections was 3 points, in the distal 2 points. In the lower right limb, the strength was 4 points. There were no sensory disturbances. Speech disorders corresponded to moderate semantic aphasia, preventing the patient from understanding and retelling the meaning of the read text. The Rivermead mobility index was 8 points, the score on the Rankin scale corresponded to moderate disability. According to the FMA-UE scale according to section "A-D", 41 points were obtained, according to the ARAT scale 35 points. Score on the MOCA scale 24 points. The patient underwent speech therapy classes, classes in the framework of physical rehabilitation. In addition, the patient was asked to undergo a course of rehabilitation using APC for social adaptation.

Classes took place in the rehabilitation room in a sitting position. The patient was in the chair during the entire training procedure. The patient was fitted with a helmet for EEG recording via 21 channels. Virtual reality glasses were also put on the patient's head. A stereo camera was installed opposite the patient to assess the movements of the upper limbs. Then a program was launched that showed the patient the virtual environment of the corresponding kitchen in the patient's apartment. The patient could move with his hands, while using the installed stereo camera, the movements of the virtual and physical hands were compared. After the patient's adaptation to sensations, the process of rehabilitation of speech and cognitive impairments began, associated with the training of the semantic context of the presented instructions for interaction with objects of virtual reality. The patient was instructed to perform the action of preparing a dish from the provided products or other actions, for example, washing dishes, cleaning dishes, which implied a certain choice of a sequence of actions. The sequence of actions is accompanied by 3-5 repetitions of the verbal instruction by the rehabilitator, which has a complex semantic structure, which is a stimulus for the formation of a semantic evoked potential obtained after the summation of the EEG record corresponding to 1 second epoch after the presented verbal instruction. At the same time, a negative deviation in latency of 350-450 ms was recorded. After receiving this semantic evoked potential, which corresponded, correctly, to the verbal instruction understood by the person being rehabilitated, further training was carried out with the definition of the subject of interaction, i.e. selection of a subject in accordance with the sequence of the task being performed. At the same time, 3-5 household items were demonstrated in the context of a social task (tea brewing, cleaning, cooking). These objects are shown to the patient in his field of view, while their illumination of a different spectrum increases randomly by 100 ms. The change in illumination and backlight color was a trigger for the formation of a cognitive evoked potential, the appearance of which, due to EEG recording, testified to a correct understanding of the sequence of interaction rehabilitated with objects of virtual reality.

Classes lasted from 20 minutes at the beginning of the course to 50 minutes at the end. A total of 12 sessions were conducted with the patient, which took place daily or every other day. During the entire course of rehabilitation, no adverse events were observed. By the end of the rehabilitation course, the patient underwent a repeated neurological examination and testing on the main motor scales. According to the neurological examination, the patient had a decrease in the severity of right-sided central hemiparesis. According to the six-point scale for assessing muscle strength in the right hand, the strength increased to 4 points in the proximal parts, and up to 3 points in the distal parts. In the lower limb, the strength did not change and amounted to 4 points. Speech disorders continued to correspond to semantic aphasia, however, their severity decreased significantly, and the patient could independently retell the read texts, as well as write their presentation. The Rivermead mobility index was 12 points, the score on the Rankin scale corresponded to mild disability. According to the FMA-UE scale according to section "A-D", 56 points were obtained, according to the ARAT scale 47 points. Score on the MOCA scale 27 points.

Thus, a positive effect of classes using the claimed method of social adaptation of patients on the restoration of speech and cognitive function was noted, according to a speech therapy examination and the results of testing cognitive function. At the same time, a positive effect was also demonstrated in the restoration of motor function, which contributed to an increase in the patient's independence, a decrease in the severity of functional disorders and, as a result, an increase in social adaptation.

Claims (1)

A method for social adaptation of patients with cognitive and speech disorders, including the assessment of speech, cognitive and motor disorders, tracking their dynamics and managing the rehabilitation process, implemented in a hardware-software complex, including software for launching and conducting a rehabilitation procedure using technologies virtual reality (VR); an electroencephalograph (EEG) for recording scalp electroencephalographic activity via 21 channels, mounted on the patient's head in accordance with the 10-20 system; virtual reality glasses to ensure the demonstration of virtual scenes; a stereo camera located opposite the person being rehabilitated to ensure the capture of hand movements in order to determine the correctness of interaction with virtual reality objects; a computer for controlling a virtual scene, collecting and analyzing data coming from the EEG, characterized in that the patient is shown a social scene in VR, at the beginning of rehabilitation the patient is instructed to perform a sequence of actions in the environment demonstrated by BP, while registering the semantic potential N400 in the range of 350-450 ms will be a condition for the correct execution of the task of motor interaction with virtual objects by observing the semantic sequence; then the patient hears a sound signal corresponding to the work of the BP object, the average latent potential N1 is registered with a latency of 85-95 ms, its registration corresponds to the fact that the sound is registered by the auditory system, then the target object with which the interaction is to be interacted begins to change the illumination or deviant sounds appear, corresponding to his work, and registration of the cognitive evoked potential P300 to visual and auditory target stimuli with a latency in the range of 250-350 ms confirms the patient's ability to focus on the target virtual object, when registering this signal, the patient performs an imitation of motor contact with the object, the success of which is visualized based on data received from a stereo camera.

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