RU2438574C1 - Method of cognitive disorder correction in cerebrovascular pathology - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to neurology, and can be applied in recovery of cognitive functions for patients with cerebrovascular pathology. Schulte table is displayed at computer monitor, patient is prompted to register numbers in chronological order by left mouse click. If the task is not accomplished within specified time, number not registered by patient is highlighted by separate colour, font size changes, pulse is added, and task performance time is registered. Then next table appears on the monitor with numbers placed in another order. Exercise is taken for 10 days, once per day for 20 minutes.

EFFECT: increased efficiency of cognitive disorder rehabilitation, enhanced "game" motivation of patients, making rehabilitation process more amusing, the need to make multiple cards and other study materials eliminated.

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Description

The invention relates to medicine, namely to neurology, and can be used to restore cognitive functions (attention) in patients with cerebrovascular pathology.

There are methods for standard drug treatment of patients with cerebrovascular pathology (1).

There is a known method for the diagnosis and correction of cognitive functions, where during the patient’s various tasks using special stimulus material (text correction, filling out tables with numbers, counting operations of various difficulty levels), cognitive impairments are evaluated step by step and repeated repetition of the material improves one of the functions (memory , attention, praxis, gnosis).

The disadvantages of this method include its complexity, time-consuming, the lack of the possibility of objective monitoring and evaluation of effectiveness, high requirements for the qualifications of a neurologist or neuropsychologist (2).

There is a method of attention training using Schulte Tables, when 5 matrices of 25 cells (5 × 5) are presented to the patient, in which numbers from 1 to 25 are randomly plotted. The patient must search and call out loud in order these numbers as quickly as possible, with This fixes the time taken to complete the task (3). Based on the calculation of the average execution time of five tasks, the preservation of the possibility of concentration is assessed. The “paper” version of the tables is used only for diagnostic purposes, due to the fact that the correction method requires numerous didactic equipment (processing cards with different numbers).

The disadvantages of the above method include:

- lack of automatic prompting;

- the impossibility of emotional reinforcement of a positive result in the form of feedback from the patient;

- limited amount of stimulus material.

The objective of the proposed method is to increase the effectiveness of the rehabilitation of cognitive impairment, namely the concentration of attention in patients with acute and chronic cerebrovascular pathology.

The problem is solved due to the fact that the Schulte table is placed on the computer monitor screen, the patient is asked to fix the numbers in the chronological order with the left mouse button, if the task is not completed at the set time, the number that is not fixed by the patient is highlighted in a distinctive color, the size of the font changes, ripple occurs and the execution time is fixed tasks, after which the following table appears on the monitor screen for further task execution, where the numbers are located in a different order, e spend within 10 days, once a day for 20 minutes.

The method is carried out: the Schulte table is placed on the computer monitor screen, the patient is asked to fix the numbers in the chronological order with the left mouse button, if the task fails at the set time, the uncommitted number is highlighted in a distinctive color, the size of the font changes, and ripple occurs. An indication of the highlighted digit with the left mouse button returns it to its previous form, which allows the patient to continue the task. The time taken to search for a single number may vary depending on the degree of impaired attention of the patient and is set by the instructor. Upon completion, the time taken to complete the task is displayed. Then the following table appears on the monitor screen for further task execution. The lesson is held once a day for 20 minutes. The proposed method of training concentration is based on the principle of biological feedback.

The possibility of game actualization significantly increases the patient's motivation for classes and from a passive object of medical intervention, he turns into an active subject, which has a direct impact on his recovery.

We examined 25 patients in the acute period of ischemic stroke, with cognitive impairment of varying severity. The diagnosis of stroke was confirmed by MRI of the brain.

Patients in the study and control groups received standard drug therapy, taking into account existing concomitant diseases.

Assessment of cognitive functions was carried out in the acute period of ischemic stroke (2-5 days after the onset of symptoms), a re-evaluation of cognitive impairment was carried out 10 days after the initial one.

The study group consisted of 15 people who, in addition to drug therapy, underwent a rehabilitation course using a computerized Schulte table for 10 days 1 time per day, the duration of one lesson was 20 minutes. The control group consisted of 10 people.

To confirm the effectiveness of the proposed method, generally accepted tests for evaluating cognitive functions were used: a questionnaire for relatives on the cognitive state of an elderly person (IQCODE), a brief scale for assessing mental status (MMSE), a battery of frontal dysfunction tests (FAB), a clock drawing test (clock), "proofreading table ”(modification of the test by V.N. Amatuni), with the help of which the fatigue index (IU) was determined. At the same time, the dynamics of motor, sensory and other neurological disorders were assessed according to the National Institute of Health (NIHSS) stroke scale. Patients in the control and study groups did not have differences in the severity of cognitive impairment according to the results of testing using these methods.

Against the background of the classes using the biological feedback method using a computerized Schulte table, a significant regression of the severity of cognitive and motor impairment was noted. A significant improvement in cognitive functions against the background of the classes was indicated by the positive dynamics of the results of most neuropsychological tests that were used in the study. Improved memory, concentration and switching attention. Compared with the control group, a statistically significant positive effect of correction of cognitive impairment was noted (z = 3.4 at p = 0.0003).

Example: Patient T., 69 years old, male. Diagnosis: Ischemic stroke in the pool of the right middle cerebral artery with left-sided hemiparesis syndrome.

Background: Hypertension 3. Risk 4. Cerebral atherosclerosis.

Sop: Type 2 diabetes mellitus, moderate, compensation.

From the anamnesis: Suddenly, March 3, 2010, against the background of HELL 170/100 mm RT. Art. there was a weakness in the left limbs, an ambulance delivered to the State Clinical Hospital No. 6.

Secondary education.

In neurological status upon admission: Consciousness is clear. There are no oculomotor, bulbar disorders. Asymmetry of the left nasolabial fold. Tongue in the midline. Left-side hemiparesis with muscle strength in the hand in the proximal 1b, in the distal 2-2.5b, in the leg 3.5-4b. Muscle tone in the left limbs is reduced. Tendon reflexes S> D. There are no sensitive violations. There are no meningeal signs.

According to the results of the additional examination:

MRI of the brain - in the frontal, parietal, occipital and temporal lobes on the right, intra- and subcortical areas of ischemia, with uneven fuzzy contours from 1.5 to 3.0 cm.

MRA of cerebral vessels - a variant of the development of the Willis circle. Moderate asymmetry of blood flow in the visible parts of the vertebral arteries. Blood flow asymmetry in the visible sections of the internal carotid arteries, midbrain arteries, and anterior cerebral arteries.

SMAD Systolic-diastolic hypertension is not registered.

Xc 3.35; b-LP 28; HC LDL 1.81; HDL cholesterol 1.04; PA 2.2; TG 0.99

Ocular fundus. Closed: hypertensive angiopathy.

The following methods were used to evaluate cognitive functions: a brief scale for assessing mental status (MMSE), a battery of frontal dysfunction tests (FAB), a clock drawing test (clock), and a “proofreading table” (modification of a sample of V.N. Amatuni), which was used to determine fatigue index (IU). At the same time, the dynamics of motor, sensory and other neurological disorders were assessed according to the National Institute of Health (NIHSS) stroke scale.

The patient makes contact, is oriented in a place and time, spontaneous speech activity is preserved. Dynamic praxis - difficulties in mastering and holding the motor program (fist-rib-palm), its simplification and slowdown, mainly in the left hand. Visual object gnosis is generally preserved. Auditory non-speech gnosis - rhythm reproduction is impaired. Spatial gnosis (test drawing hours, redrawing figures) is violated.

Modally non-specific mnestic violations - with difficulty assimilates new information, reproduction is violated.

Conducted standard drug therapy, taking into account concomitant diseases and rehabilitation using a computerized Schulte table in order to correct attention disorders, for 10 days 1 time per day, the duration of one lesson was 20 minutes.

The time of the Schulte test on different days and the time of classes varied from 86 to 120 seconds.

When conducting a proof test, the fatigue index was 0.95, which indicates increased fatigue, a decrease in the level of active attention and mental performance.

T.O. neuropsychological symptoms indicate dysfunction of the cortical-subcortical parts of the frontal lobes, dysfunction of the deep median structures of the brain.

As a result of the rehabilitation, an improvement in cognitive functions was reliably observed, as evidenced by the positive dynamics of most neuropsychological tests used in the study (Table 1).

Table 1. The results of the correction of cognitive impairment in patient T. by the proposed method. Dynamics MMSE Fab Nihss Clock Yiwu Before classes 27 points 13 points 7 points 8 points 0.95 After classes 29 points 15 points 3 points 9 points 0.99

As follows from the data presented, the patient has improved memory, increased level of active attention.

The proposed method allows you to:

- use it to correct cognitive impairment, including attention;

- increase the “game” motivation of patients (test design in the form of a game), which makes the rehabilitation process more attractive, increasing the effectiveness of rehabilitation treatment in acute and chronic cerebrovascular pathology;

- conduct classes for a general practitioner, exercise instructor or patient’s relatives;

- adjust the degree of load;

- eliminate the need for registration of numerous cards and other didactic material.

Bibliography

1. The protocol for the management of patients "Stroke", regulatory documents approved by the deputy. Minister of Health and Social Development of the Russian Federation V.I. Starodubov from 02.10.2005, OJSC PP "Siberia".

2. Chomskaya E.D. Neuropsychology. - SPb .: Peter, 2007, 2nd ed .; - 496 p.

3. Burlachuk, L.F. Dictionary Guide for Psychodiagnostics. / L.F. Burlachuk, S.M. Morozov // St. Petersburg, Peter, 1999 .-- 528 p.

Claims (1)

A method for the correction of cognitive impairment in cerebrovascular pathology, including the use of Schulte tables, characterized in that Schulte tables are placed on the computer screen, the patient is asked to fix the numbers in the chronological order with the left mouse button, if the task is not completed at the set time, the uncommitted number is highlighted in a distinctive color, the size changes styles, ripple occurs and the time of the task is fixed, after which the following table appears on the monitor screen, where the numbers are arranged in a different order, the lesson is held for 10 days, once a day for 20 minutes.