Психофизиологическая диагностика пациентов с очаговыми поражениями головного мозга на этапе стационарной реабилитации

Постановка проблемы. В России актуальность диагностики и реабилитации пациентов с очаговыми поражениями головного мозга, такими как острое нарушение мозгового кровообращения, опухоли и черепно-мозговые травмы, растет с каждым годом. Психофизиологические особенности очаговых повреждений головного мозга изучены недостаточно. Цель - выявить психофизиологические особенности пациентов с очаговыми поражениями головного мозга, влияющие на адаптивность пациента и способность к социализации через метод простой зрительно-моторной реакции. Результаты. Результаты исследования показали, что в среднем у пациентов с острыми нарушениями мозгового кровообращения процесс восстановления психофизиологических показателей идет медленнее, чем у пациентов после черепно-мозговой травмы, что может быть связано с обширностью и тяжестью повреждения головного мозга, а также с возрастом пациентов. Практическая значимость. Полученные результаты могут быть использованы для оптимизации лечения и реабилитации пациентов с очаговыми повреждениями головного мозга.

Psychophysiological diagnosis of patients with focal brain lesions at the stage of inpatient rehabilitation

Each focal lesion of the brain is always accompanied with a pronounced dynamic oppression of the function beyond the limits of this destroyed trauma zone. Focal lesions of the brain are manifested with neurological symptoms, they lead to a significant disruption of the psychophysiological apparatus, affecting the entire life of the patient as a whole, its adaptability and ability to socialize. Along with other methods of psychophysiological research, there is a simple visual-motor reaction, which is an elementary form of an arbitrary human response to a visual stimulus, which includes two successive components: the sensory (latent) and motor period. There are the main quantitative criteria that allow to characterize the current functional state of the nervous system: the overall functional level of the system, the stability of the reaction and the level of functionality. The aim of this study is to identify the psychophysiological characteristics of patients with focal brain lesions that affect the adaptability of the patient and the ability to socialize through the method of simple visual-motor reaction. The study involved 15 patients (10 men, 5 women; middle age 53,13+ 20,66) with severe focal brain lesions, located in the Department of neurorehabilitation of Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology. Psychophysiological study of simple visual-motor reaction (SVMR) was carried out with the help of computer hardware-software complex “NS-Psychotest”. The results were processed on the basis of the standard deviation and the average reaction time, where the standard deviation showed the stability of the sensorimotor response, and the average value - the average rate of (SVMR), characteristic of each patient individually. In the process of psychophysiological testing, 5 indicators were taken into account: the functional level of the system, the stability of the reaction, the level of functionality, the total number of errors and the reaction time. When assessing the functional level of the system (FLS), it was found that 46.67% of the examined patients have a pathological functional level of the system, which indicates an imbalance in the functioning of the central nervous system and may be associated with the volume of brain damage. In assessing the stability of the reaction (SR), it was found that 26.67% of patients had pathological stability of the reaction, 13.33% - low, 33.33% - medium and only 26.67% - high. According to this indicator, it was also found that low and pathological stability of the reaction was more often observed in patients after stroke, which once again confirms that in patients after traumatic brain injury, the preservation of higher mental functions is higher in the average from the sample compared with patients after stroke. The level of functionality (LF) in General may indicate the rehabilitation potential of the patient. In assessing this indicator, it was found that 33.33% of patients have a pathological level of functionality, which suggests a low rehabilitation potential of these patients. 66.67% of patients fall under the standard of LF, of which 6.67% with low rates, 46.67% - with the average and only 13.33% of patients with high. A sufficiently high percentage of patients with medium and high FLS allows us to make an optimistic conclusion about the probability of full or partial recovery of the patient to the premorbid level in the rehabilitation process or a high level of rehabilitation potential. The total number of errors of the 15 patients in the rule was 26.67% patients of 73.33% of patients were identified with errors, of which of 46.66% had gross impairment (5 with stroke and 2 with traumatic brain injury). Such a high percentage of patients with severe impairment indicates pronounced attention and switching problems and the need for daily cognitive training for this group of patients. According to the average reaction time, 3 types of reaction were revealed: inert (60%), intermediate (33.33%) and mobile (6.67%).). A high percentage of the inert type of response in the case of patients who have suffered a brain catastrophe, indicates, first of all, the inclusion of physiological mechanisms of protective inhibition, which is a kind of innate inhibition that protects the nervous system from further harmful effects of strong or prolonged stimulus, namely, from excessive load and exhaustion. The results of the study, obtained in the analysis of visual-motor reactions in patients with focal brain lesions, revealed that, on average, in patients with stroke, the process of restoring psychophysiological parameters is slower than in patients after TBI. These results expand the understanding of the features of the restoration and functioning of the brain in various pathologies of the brain and indicate the need to correct the duration of rehabilitation measures, taking into account the etiology of brain damage. Psychophysiological diagnosis helps to assess the adaptive capacity, rehabilitation potential of the patient at the time of admission to the hospital, as well as to predict possible deviations in the state of neuropsychiatric health after discharge from the hospital.