RU2392916C1 - Method of early recovery of cognitive functions in patients suffered stroke - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to restorative medicine, neurology, exercise therapy and can be used in integrated treatment in the patients suffered stroke in the early recovery period. That is ensured by graduated physical activity including homolateral, heterolateral and cross motions, auto-training, unit-directional and multidirectional motions of eyes, language and extremities. Herewith, the patient makes daily set physical exercises of "cognitive gymnastics", consisting of the following types of exercises: general exercises, power exercises, neck muscle stretch in postisometric relaxation, and ending with a set relaxation exercises with auto-training elements and self-massage techniques. Each exercise lasts for 1-2 minutes at a slow and gradual pace; the exercises are daily, twice a day. And according to a motor mode, in a partial load mode, the exercising time is 10-15 minutes, in partial load training mode - 15-20 minutes, in training mode - 25-30 minutes, with the beginning positions - standing, sitting on a chair, and for patients with persistent vertigo - laying; the therapeutic course is 15-18 procedures.

EFFECT: method is simple and allows improving life quality of the patient, increasing level of communications, lowering degree of fatigue and ensuring higher vital activity of the patients.

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Description

The invention relates to medicine, in particular to rehabilitation therapy, neurology, physiotherapy exercises, and can be used in comprehensive rehabilitation in patients who have had a stroke in the early recovery period.

A known method for the correction of cognitive functions by vascular nootropic drugs (phenotropil, lobaron), which have a complex effect on metabolic processes and blood circulation of the brain (Gusev EI, Gekht AB, Gaptov VB, Tikhopoy EV Rehabilitation in neurology. Textbook. - M., 2000., 327 pp.).

The disadvantage of this method: with medical treatment, for all its importance, the patient takes only a passive part in the recovery process, while the active participation of the patient in the recovery process creates positive motivation for recovery. Many drugs require long-term use, have side effects and unpredictable long-term effects. In addition, patients often do not have the opportunity to use expensive drugs, especially when multi-month maintenance therapy is required.

The closest to the achieved result is the method of neuropsychological training through physical exercises "Brain Gym", which is used in the field of education to improve the learning ability of children. It uses a set of exercises aimed at improving interhemispheric connections (Dennison, P. Brain Gym - Teachers Edition / P. Dennison, G. Dennison // Ventura, CA: Edu-Kinesthetics, 1994. - 91 p.).

Disadvantages: the known method is not used in the practice of restoring cognitive functions in sick people, but is used in primary and special school education. In addition, the general state of health is not taken into account, the above complex uses exercises without taking into account the phylogenetic and ontogenetic organization of the brain with its gradual complication, there are no methods for postisometric relaxation of the neck muscles to improve cerebral blood flow, moreover, the exercises in it are given as a general recommendation, and may not always be understood by elderly patients, especially after a stroke.

The authors propose a highly effective method of non-drug treatment that allows you to have a positive effect on cognitive functions, improve the quality of life, reduce the restrictions on social contacts and the level of communication, reduce fatigue and increase the vitality of stroke patients. It is based on specific physical exercises, in combination with point self-massage, which contribute to the integration of brain activity. The proposed method is not stressful and can be used to treat patients after a stroke in the early recovery period.

The technical result of the claimed invention is to increase the effectiveness of rehabilitation in patients after a stroke in the early recovery period.

The technical result is achieved by the fact that in addition to drug treatment with vascular nootropic drugs and physical rehabilitation methods (therapeutic exercises), patients undergo a set of physical exercises, namely “cognitive gymnastics”.

The method is as follows.

Against the background of comprehensive rehabilitation, which includes medical treatment, massage, therapeutic exercises, local magnetotherapy, a set of physical exercises “cognitive gymnastics” is carried out. All types of exercises are conditionally divided into four groups. When performing the complex, an indissoluble connection between exercises and simultaneous use of, for example, muscle stretching exercises with homolateral movements and oculomotor exercises, is necessary, and relaxation exercises are performed in combination with self-massage elements and post-isometric neck muscle relaxation techniques. Only in this case, conditions are created for the activation of connections between the centers that control the movements of the limbs, the oculomotor nuclei of the brain stem, the visual centers and the cerebral cortex on the right and left.

1. General developmental coordination (bodily) exercises, which are divided into one-sided (homolateral) movements, versatile (heterolateral) movements, movements that intersect the midline of the body. When performing body movements, hemispheric interaction develops, the lower parts of the brain stem are activated, involuntary, inadvertent movements and muscle clamps are removed.

2. Exercises that stretch the muscles of the neck in the mode of post-isometric relaxation help release the muscles of the neck from prolonged stress and allow you to indirectly improve the state of cerebral blood flow.

3. Exercises that increase the energy of the body, which include unidirectional and multidirectional movements of the eyes, tongue and limbs, developing interhemispheric interaction and increasing the energy of the body, help improve perception.

4. Exercises for relaxation, which contribute to relaxation, self-observation, stress relief. This group includes exercises performed with elements of auto-training, self-massage and fine motor training.

The duration of each exercise is 1-2 minutes. The pace of the exercise is slow, smooth. Classes are held daily in accordance with the motor regime - in the gentle mode, the training time is 10-15 minutes, in the gentle trainer - 15-20 minutes, in the trainer - 25-30 minutes. The class of “cognitive gymnastics” is carried out in the form of a set of exercises, which includes the preparatory, main and final parts. In the preparatory part of the complex, general developmental exercises are carried out, in the main part of the general developmental exercises are combined with energy exercises, at the end of the main part of the complex exercises are stretching muscles. In the final part of the complex relaxation exercises are used. Classes are conducted by a physical therapy doctor, who doses the exercises in accordance with the clinical picture of the disease and the general well-being of the patient. The course of treatment in a sanatorium is 15-18 procedures. The initial positions proposed for implementation are standing, sitting on a chair, and for patients with persistent dizziness, lying down.

The criteria for the effectiveness of the therapeutic effect were - a clinical neurological study, psychological testing - an abbreviated multifactor questionnaire for personality research (SMOL) (Zaitsev VP Psychological test SMOL. Actual issues of regenerative medicine. - 2004. - No. 2. - P.17-19 .), memory assessment by tests: “Memory for images”, “Memory for numbers” (Luria AR Higher human cortical functions. M .: Academic project. - 2000. - 504 p.), attention to “Tables Schulte "(Kirdyashkina TA Methods of research attention. Workshop on psycho of logic: textbook Chelyabinsk: Publishing house of SUSU, - 1999. - 72 pp.), the level of cognitive impairment according to the Mini-Mental State Examination (MMSE) test (Folstein, MF, Folstein, SE, McHugh, PR “Mini-Mental State” : a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 1975, N 12. - P.189-198), quality of life according to Health Status Survey (SF 36) (Ware JE, Kosinski M ., Keller SD SF-36 Physical and Mental Health Summary Scales: A User's Manual. The Health Institute, New England Medical Center. Boston, Mass. - 1994. - 87 p.).

The study was carried out in 2 stages: 1st - at the beginning of treatment in the rehabilitation department; 2nd - 3-4 days before discharge.

According to clinical tests, the improvement observed in patients had objective confirmation. After a course of complex treatment with the inclusion of cognitive gymnastics, there was an improvement in well-being, an increase in motor capabilities and a decrease in dizziness.

According to psychological testing, the results of the study showed a significant improvement in indicators of short-term verbal memory and voluntary attention. The data obtained indicate a decrease in the limitation of social contacts and level of communication, due to the state of physical and emotional health, a decrease in the degree of fatigue and an increase in vital activity, indicate an improvement in mood, a decrease in the level of astheno-neurotic reactions and care for the disease, an increase in self-esteem and a critical assessment situations, increased attention rates.

When studying the dynamics of indicators of short-term memory, it turned out that indicators of short-term memory improved. Patients began to memorize more words, solve more examples in the allotted time interval, and make fewer mistakes when performing tests. An analysis of the results of a study of attention in the Schulte Tables test showed that the minimum time required for patients to find all the numbers on the tables was reduced as well as the average time for five tables, the number of pauses (“jams”) decreased.

The results of the study of the quality of life of patients (SF-36) indicate positive changes in physical, psychological, social functioning in terms of “physical pain”, “physical activity”, “vitality”, “emotional role”, “mental health”, and also confirm the increase the capabilities of stroke patients.

Clinical example 1

Patient Shakhova Natalya Vasilievna, 46 years old, was admitted to the aftercare department of the Barnaulsky sanatorium after inpatient treatment for a stroke with complaints of headaches, dizziness, memory loss, weakness, and sleep disturbance.

Diagnosis at admission: Acute cerebrovascular accident according to the type of small ischemic stroke in the vertebrobasilar basin, vestibulo-atactic syndrome, cephalgic syndrome. Concomitant diseases: arterial hypertension, osteochondrosis of the cervical spine, abdominal obesity of the II degree.

According to a neurological study revealed - mild degree of motor impairment, mild impairment of coordination, swaying in the Romberg test, asthenia, errors in the study of dynamic praxis, decreased memory and attention, difficulty concentrating if necessary, slowing down mental activity. In the study of the psychological profile and quality of life revealed - an increase in the level of hypochondria, a decrease in vital activity and a sharp decrease in physical functioning.

A patient against a background of comprehensive rehabilitation, including drug therapy, massage, medical gymnastics, local magnetotherapy, conducted a course of classes using the method of "cognitive gymnastics" in the amount of 30 procedures, 2 times a day. Classes were held in a group method for 25 minutes, special exercises were alternated with general developing ones in a ratio of 1 to 2. Starting positions were alternated - sitting, standing. The procedure was carried out daily except Sunday

Immediately after the course of treatment, the patient noted improvement in well-being, dizziness decreased, “clarity in the head” appeared, gait became more confident, weakness decreased. The study of memory and attention showed an increase in the volume of memorized images and numbers, which indicates an increase in the volume of short-term memory, as well as an improvement in voluntary attention.

Also, according to the results of the SMOL questionnaire, a decrease in the level of hypochondria, depression was revealed. The study of quality of life by the SF-36 test revealed a significant improvement in the patient's quality of life according to the following indicators: “physical activity”, “vitality”, “emotional role”, and “mental health”.

Clinical example 2

Patient Belorybkin Nikolay Ivanovich, 56 years old, was sent to the aftercare department of the Barnaulsky sanatorium after inpatient treatment for a stroke with complaints of headaches, instability when walking, sleep disturbance, instability of attention, memory impairment for current events.

On examination, there are signs of mild left-sided paresis, a second degree of disturbance in social and household activity, staggering when walking, there is a decrease in memory, thinking disorders (slowing its pace, excessive detail), performance is reduced.

Diagnosis: Acute cerebrovascular accident according to the type of ischemic stroke in the projection of the right midbrain artery, accompanied by mild left-sided hemiparesis in the presence of hypertension 2 tbsp., Risk 4.

Against the background of comprehensive rehabilitation, which included drug therapy, massage, therapeutic exercises, local magnetotherapy, biofeedback with feedback, a course of classes on the method of "cognitive gymnastics" in the amount of 15 procedures was carried out. Classes were held in a small-group method for 25 minutes, special exercises were alternated with general developmental ones in a ratio of 1 to 2. Starting positions were mainly sitting. The procedure was carried out daily, except Sunday.

After a course of treatment, the patient noted improvement in well-being, mood, increased activity, gait became more confident, weakness decreased. The study of memory and attention showed an increase in the volume of memorized images and numbers, which indicates an increase in the volume of short-term memory, as well as an improvement in voluntary attention. The study of the quality of life by the SF-36 test revealed a significant improvement in the patient's quality of life according to the scales: physical functioning, the influence of the emotional state on role functioning, life activity. The data obtained indicate a decrease in the limitation of social contacts and the level of communication in connection with the state of physical and emotional health, a decrease in the degree of fatigue and an increase in vital activity.

The favorable dynamics of the functional state of cognitive functions and the clinical manifestations of the disease under the influence of exercises “cognitive gymnastics” indicates distinct positive changes in the process of recovery of the body after suffering an acute violation of cerebral circulation.

Thus, the claimed method of treating stroke patients in the early recovery period is highly effective in restoring cognitive deficits, is easy to use, works from the perspective of positive motivation, which allows it to be used in complex treatment at any stage of rehabilitation. The method can be applied in outpatient, inpatient, spa treatment conditions, and can also be used for self-study at home.

Claims (1)

A method for the rehabilitation of cognitive functions in patients after a stroke in the early recovery period, which consists in the use of dosed physical activity, including homolateral, heterolateral and cross movements, auto-training, unidirectional and multidirectional movements of the eyes, tongue and limbs, characterized in that the patient is given a daily set of physical exercises "Cognitive gymnastics", consisting of the following types of exercises: general developmental exercises, energy exercises, exercises, neck tensile muscles in post-isometric relaxation mode, ending with a set of exercises for relaxation with the help of auto-training elements and self-massage techniques; the duration of each exercise is 1-2 minutes, the pace of exercise is slow, smooth; classes are conducted daily 2 times a day, in accordance with the motor regime - in the gentle mode, the training time is 10-15 minutes, in the gentle-training - 15-20 minutes, in the training - 25-30 minutes, and the starting positions are standing, sitting on stool, and for patients with persistent dizziness - lying down; the course of treatment is 15-18 procedures.