[Differentiated approach to cognitive rehabilitation of patients after stroke]
A V Kotelnikova1, A A Kukshina1, E A Turova1
1S.I. Spasokukotsky Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia.
Abstract:
Post-stroke cognitive impairments are widespread and significantly reduce the quality of life and rehabilitation prognosis of patients. Clinical observations show a serious variability of cognitive impairments in patients after acute cerebrovascular accident. Thus, the classification of above mentioned disorders, based on which it would be possible to determine the order of individualization of a cognitive rehabilitation program, is currently not available in literature.
Objective:
To scientifically establish the differentiated approach to cognitive rehabilitation by verification of patients groups, differing in the structure of post-stroke complications.
Material And Methods:
Cognitive status of 45 patients in the early rehabilitation period after ischemic stroke (26 (57.8%) women, 19 (42.2%) men aged 63.0±8.0 years), who underwent inpatient treatment stage of medical rehabilitation was studied by means of «Short neuropsychological examination of cognitive sphere (SNECS)» methodology. Indicators of neurodynamics according to the domains of the International Classification of Functioning, Disability and Health were considered as well.
Results:
The conducted neuropsychological study revealed 4 groups of patients, 3 of which had a significant cognitive functions' deficiency, manifested in the 1st group by reduced indicators of psychomotor control level (neurodynamic impairments, asthenia, exhaustion), executive functions, ability to analytical-synthetic activity, attention and working memory; in the 2nd group - by reduced ability to perform graphical test tasks on constructional praxis and reproduction of sequences' set; in the 4th group - by reduced indicators of «unfinished images» test task performance, reflecting state of visual object gnosis. Cognitive functions' state in the persons of the 3rd group was assessed as satisfactory.
Conclusion:
The present study provides an attempt to classify cognitive disorders in patients who underwent stroke aimed at the formation of differentiated cognitive rehabilitation programs. As a result, 4 groups of patients, differing in the structure of post-stroke complications, were verified, and the directions of rehabilitation work for each of them were indicated in the cognitive functions investigation using «SNECS» methodology.
