TOWARDS PSYCHOLOGICAL SUPPORT IN INTERACTIVE STROKE REHABILITATION THERAPY (EEG-FMRI STUDY)
Authors: Mazhirina Ksenia G. , Khrushcheva Nadezhda A. , Savelov Andrey A. , Shurunova Anastasia V. , Kalgin Konstantin V. , Shtark Mark B. 
Published: February 2024

Highlights

Interactive 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.