Method for rehabilitation of patients suffered stroke

FIELD: medicine.

SUBSTANCE: patient is trained by challenging to imagine a paretic limb movement and controlling the imagined movement. An electroencephalography is recorded; the recorded data are transferred to a computer for synchronous processing, and arousal reaction signals of a sensorimotor rate responsible for the imagined movement are isolated by means of an EEG pattern classifier according to the Bayes method. Identification results of the mental challenge are presented to the patient by a visual feedback in the form of a mark on a monitor. The mark re-position testifies to accuracy of the challenge. The imagined movement challenge is presented for 10 seconds. The training course makes 6-12 days, one training a day, of the length of 20-30 minutes every 1 to 4 days.

EFFECT: method provides more effective rehabilitation that is ensured by the feedback training in the conditions enabling the patient controlling the imagined paretic limb movement visually.

3 dwg, 4 tbl, 2 ex

 

The invention relates to medicine, in particular, neurology, and can be used to restore motor function in patients with ischemic stroke and have a gross motor disorders.

It is known that repetitive active targeted traffic significantly contribute to the restoration of motor functions. In patients with stroke, in addition to physical therapy this approach over the last 10 years is implemented in such methods, as training in virtual reality, when patients learn the movements for feedback, and training in the conditions, when the movements are facilitated by the robot (Chernikova L.A. brain Plasticity and modern rehabilitation technologies. Annals of clinical and experimental neurology, 2007, 1(2):40-47).

These methods require saving opportunities to make active movements of the paralyzed limb and, therefore, require partial preservation of motor function. In case of severe paresis or plegia promising method of stimulating brain plasticity is the imagination of movements. Physiological mechanisms underlying the process of imagination movements, largely similar to the mechanisms of motor control and, therefore, can stimulate the same plastic mechanisms of the brain, the actual execution is their movement (Neuper C, Scherer R., Reiner M, Pfurtscheller G. Imagery of motor actions: differential effects of kinesthetic and visual-motor mode of imagery in single-trial EEG. Cogn. Brain Res. 2005. 25(3): 668-677).

Today, there is a method of rehabilitation of patients with stroke, by training the patient "accuracy Tong" using biofeedback with feedback electromyogram (EMG). For training of precision grip using a hardware-software complex "BOSLAB" (, Novosibirsk). EMG electrodes placed on the muscles of the exaltation of the thumb. The patient squeezes the thumb and forefinger of a small object, and is trained to maintain a specific level of muscle activity in 20, 40 or 60% of maximum contraction. On the screen the patient sees the specified level of EMG in the form of a corridor, and changes its integrated EMG. The problem consists in the combination of EMG level with the specified corridor and holding muscular tension within 30 sec. After each sample, the patient is maximally relaxes muscles under visual control (training overcome spasticity), and then tries to reproduce the required level of EMG from memory, not seeing EMG on the screen, i.e. without visual control. The duration of the session is 20-25 minutes training Course consists of 10 daily sessions. (Chernikova L.A., Ioffe M.E. Ter-Minassian, Bosenova S.N., Shestakova M.V., Belonenko AU Electr the myographic biofeedback and functional magnetic resonance imaging in post-stroke rehabilitation (for example, the learning accuracy Tong). Bulletin of Siberian medicine, 2010, No. 2, p.12-16).

This allows you to actively included in musculoskeletal rehabilitation biofeedback, organized by electromyogram and aimed at the production of precision movements of the fingers of the hand in patients with mild and moderate paresis and impaired fine motor skills of hands, however, does not provide a full rehabilitation in patients with gross motor disorders.

The technical result consists in increasing the effectiveness of rehabilitation in patients with stroke and have a gross motor disorders due to the effects of the exercise of the imagination of movement on the neurophysiology of cortical motor representations, which ensures an increase in excitability of the motor cortex.

The technical result is achieved by the fact that the rehabilitation of patients with stroke is carried out by training paretic limb, with training conducted, showing a sick job on the imagination of movement of the paretic limb with the subsequent control of the imagination of movement of patients, based on the analysis of patterns in the electroencephalogram (EEG), arising from imagination of movement of the paretic limb, and the registration of EEG brain signals is performed with system active electrodes entsefalografa placed on the surface of the head is, and transmit such data to a computer for their synchronous processing and separation of signals responsible for the perception of motion by using the classification of EEG patterns, Bayesian recognition results performed mental tasks placing the patient on a visual feedback from the validation task on the monitor screen, and the job on the imagination of movement present in 10 seconds, the training paretic limb is 6-12 days, one workout per day, 20-30 minute intervals between training sessions from 1 to 4 days.

The method is as follows.

For rehabilitation of patients with stroke, use the technology with feedback interface brain - computer (IMC). The patient in real-time receives visual information about the activity of his brain.

The IMC consists of the following elements (figure 1): system active electrodes ActiCap firms Brain Products, Germany) for recording the electroencephalogram (EEG) (1), encephalographic analog-to-digital Converter (ADC) NBL640 production LLC Neurobiol" (2), personal computer (Windows 7) for synchronous data transfer, separation performance of EEG and classification of signals for recognizing a control command is s real-time (3) (beavers P.D., Korsakov A.V., and other Bayesian approach to the implementation of the interface brain-computer-based representation of the movements. Journal of Higher Nervous Activity and Neurophysiology, 2012, 62(1):89-100).

During the training session, the patient sits in a comfortable chair so that the head is at a distance of 1 m from the computer monitor on which he produces visual tasks and feedback (information about the correctness of the job). In the center of the screen there is a circle that is used to fix his gaze, and surrounding 3 diamond arrows, which are indicated on the block diagram layout IMC used in this rehabilitation process (Fig.1). The patient during the training performs one of three tasks: to relax (when lit upper arrow), to represent the movement of the left or right hand (lights up when the corresponding left or right arrow). As a representation of hand movements offer to imagine the slow compression of the brush in a fist. On assignment to relax (rest) the patient must sit and watch in the center of the screen. Job show in random order, each for 10 seconds. The results of the detection performed mental tasks require the patient for visual feedback: the label in the middle of the screen, locking eyes, takes a green color, if the classifier RA who knows the task, relevant requirements of the job movement, and remains white if the task was not recognized.

Registered EEG performed using 30 electrodes placed on the surface of the patient's head, according to the scheme 10-20 (Zenkov LR Clinical electroencephalography (with elements of epilepsy). A guide for physicians. 3rd ed., M: Representors, 2004, 368 C.). Under each electrode a special gel to improve the contact with the surface of the patient's head. The EEG signals filtered in the frequency band from 5 to 30 Hz. In this method was applied to the classification of patterns of EEG based on Bayes method (beaver P.D., Korsakov AV and other Bayesian approach to the implementation of the interface brain - computer-based representation of the movements. Journal of Higher Nervous Activity and Neurophysiology, 2012, 62(1): 89-100). As a measure of the classification accuracy using index "Kappa Cohen's" (under ideal recognition K=1, accidental detection K=0) (Kohavi, R., Provost F. Glossary of terms. Machine Learning - Special Issue of Applications of Machine Learning and the Knowledge Discovery Process, 1998, 30: 271-274) and the percentage of correct answers classifier (recognition above at random > 35%). Identifying sources of activity that are most important for the functioning of the IMC was conducted using the method of independent components (ICA, Independent Component Analysis (A. Frolov, D. Husek et al. Comparison of four classification methods for brain computer nterface, Neural Network World, 2011, 21(2): 101-111).

With each patient rehabilitation should be performed within 6-12 days one training per day, lasting 20-30 minutes. The intervals between training sessions range from 1 to 4 days.

The study aimed to compare the quality of management of IMC in patients with focal brain damage in healthy people, as well as to assess the effectiveness of this technique for the rehabilitation of stroke patients .THE study involved 36 patients with hemiparesis of Central origin, including 26 men and 10 women, ranging in age from 34 to 70 years, with disease duration (stroke or brain injury) from 1 month to 8 years (median duration of the disease was 11.5 [3; 21,5] months). In the early rehabilitation period there were 14 patients in late and residual 22 patients. In all patients the clinical picture was observed very rough paresis or plegia in the hand, the median scale ARAT=0 [0; 4]. 16 of the patients was the main group, in complex treatment which included training of IMC, and the comparison group, consisting of 20 patients who received only traditional complex therapy. The core group and the comparison group were matched for age, duration of stroke and the degree of neurological deficit. In addition, the study involved 7 healthy volunteers in the age is e from 24 to 68 years, 6 men and 1 woman. All subjects are right - handed (according to the Edinburgh questionnaire manual asymmetry: R > 40%).

Thirteen patients of the main group (3 patients dropped out after the first session on their own) and all healthy subjects underwent a course of IMC-training, in which job on the imagination of movement was presented for 10 seconds and perform one workout per day, 20-30 minute intervals between training sessions from 1 to 4 days. Results management IMC for trained patients in both groups are presented in table 1 (data are presented as median and 25%and 75% percentiles).

Table 1
Achieved values recognition classification of mental tasks (rest, imagination, movement of the left hand and the imagination of right hand) the subjects of the two groups
Kappa Cohen% recognition
The main group (patients with gross paresis or plegia in hand), have a course of IMC-training0,37 [0,19; 0,43]55,5 [45; 59,5]
A group of healthy subjects who received course IMC-training/td> 0,33 [0,22; 0,44]54 [47; 63]
U-testR=0,77R=0,98

For quality control interface (Kappa Cohen and percentage of recognition) differences between groups were not found (P>0,05). This allows us to conclude that patients with focal brain damage in the state to seize control of the IMC with the same quality that people without neurological disorders.

Figure 2 shows the distribution of the contribution of the component potentials recorded on the head surface (topographic distribution), and the spectral density of activity for this component (for one of the healthy subjects). Topographic distribution of significant management IMC components and their spectral density at the three mental States - "norm". The abscissa axis is the frequency in Hertz, on the y - axis spectral density normalized by the maximum value. The peak of the spectral density for this component corresponds to the range of sensorimotor rhythms (mu rhythm). During imagination of movement is a reaction of de-sensorimotor rhythm in the corresponding hemisphere (bottom curve on the graph of the spectral density).

This distribution of potentials and changed the e mu rhythm during imagination of movement was observed in healthy subjects and was taken as the "norm".

Figure 3 shows the topographic distribution of the significant component and the spectral density of the intensity at three mental conditions (rest, imagination, movement of the left hand and the imagination of right hand): (A) a patient with subcortical brain damage; B) a patient with damage to the motor cortex. Among patients met the following options distribution of the contribution of the component potentials depending on the localization of stroke: in subcortical localization of the lesion there was a picture similar to the "norm" (fig.3a), and if damaged motor cortex was observed abnormal distribution of the contribution of the component in the damaged hemisphere: in both cases, the source signal was localized close to the projection CZ in the standard location of EEG electrodes according to the 10-20 system (risb). Significant management IMC components, as well as in healthy individuals, were associated with response timing in the range of mu-rhythm (10 patients), and beta-rhythm (1 patient, risb), or mu - and part of the beta rhythm (1 patient, fig.3a) during imagination of movement.

Among subjects in both groups met the following options for changing the activity of the brain, which was associated with the improvement of the quality management IMC (mastering the skill management IMC): a) the allocation of significant component from the first days and the greater is the reaction of desynchronization during exercise; b) the absence of any significant component in the early days and their appearance in the training process with the subsequent amplification reaction timing. Topographic distribution is not changed for each of the two components in the training result.

To assess the clinical effectiveness of rehabilitation rehabilitation of patients with Central paresis of the hand was a comparative analysis of the recovery of motor function in the main group (13 patients) and comparison group (20 patients). It should be noted that in this study, as the study group and the comparison group included patients only with plegia or very rough palsy brush with a poor prognosis for recovery movements.

Patients of the main group after rehabilitation measures revealed a statistically significant improvement in motor function of the hand (on a scale ARAT). In the comparison group significant improvement in impaired motor function were observed. The difference in improving the functionality of the hand between the groups was statistically significant (p=0.02). The results of the evaluation of the motor function of the hand in the dynamics in patients of the main group and comparison group are presented in table 2.

Table 2
The results zenkevicienes functions hands on a scale ARAT before and after rehabilitation
ToAfterP
The main group1 [0; 4,5]5 [0;16]0,01
The comparison group0 [0; 4]0 [0; 5]0,48

Thus, the data obtained allow us to conclude that it is not only healthy, but also in patients with brain damage in the imagination of the movement as a healthy and paretic hand revealed the reaction of desynchronization in the corresponding hemisphere of the brain. For the first time in the study, it was shown that the topographic distribution of the components is trained healthy subjects and patients with subcortical stroke corresponded to the location of the hand in the primary sensorimotor areas of the Central sulcus, at the same time in patients with extensive damage to the cortex during imagination of movement of the paretic hand was observed shift in the localization of the source of activity in the area of location of the Cz electrode.

The result was the revealed law, showing that patients with focal brain damage in a position the AI to seize control of the IMC with the same quality, as subjects without neurological disorders. It was not observed dependence of the quality management IMC on the extent of localization or old brain damage.

In addition, 42% of patients with plegia and rough palsy brush after training had a positive effect when using IMC training, reflected in the significant improvement of the function of the paretic hand. Therefore, the rehabilitation will speed up the pace and make a more complete recovery of impaired functions, to prevent the development of secondary complications (thrombophlebitis, contractures, pressure sores, pneumonia and congestive etc) in patients with different severity of brain lesions.

Examples of the method

Example 1

A patient, 70 years of age, ischemic stroke, disease duration 1.5 months, the focus of stroke on MRI: in the left cerebral hemisphere in a posterolateral Department lenticular nucleus with the transition to a radiant crown and hind femur internal capsule. Rough paresis hands (7 points on the ARAT scale).

Conducted a training course of 8 sessions of 20 minute intervals between training 1 day. Job on the imagination of movement was presented for 10 seconds. The achieved quality management IMC to 8 days of training: Kappa Cohen=0,42; recognition rate=70%. Management IMC was carried out at the expense of the enjoyment of the tion of de sensorimotor rhythm in the area of the Central sulcus transliterating hemisphere during imagination of movement. After the rehabilitation was observed clinically meaningful improvement in function brush (11 points on the ARAT scale, table 4). The patient independently takes the items from the table, opens the door handle.

Table 4
Improve the function of the hands, the patient A. after treatment with IMC-training
Section ARATUntil of courseAfter a courseMaximum score
Ball capture4818
Cylindrical grip2512
Pinch grip1518
Major movements009
Only71857

Example 2

The patient Century, 40 years, ischemic stroke, action Soboleva what I 21 months the focus of stroke on MRI: in the left cerebral hemisphere in the lenticular nucleus with the spread on the back of the thigh of the internal capsule, the upper sections of the hippocampal gyrus. Rough paresis hands (4 points on the ARAT).

Conducted a training course of 12 sessions, one session per day, lasting 30 minutes with intervals between workouts 4 days. Job on the imagination of movement was presented for 10 seconds. The achieved quality management IMC to 12 day workout: Kappa Cohen=0,30; recognition rate=50%. Management IMC was carried out by reaction of de-sensorimotor rhythm in the area of the Central sulcus transliterating hemisphere during imagination of movement. After rehabilitation, there was an improvement in the functionality of the hand, including the brush (13 points on the ARAT scale, table 5). The patient can take some items from the table.

Table 5
Improve the function of the hands, the patient A. after treatment with IMC-training.
Section ARATUntil of courseAfter a courseMaximum score
Ball capture1 718
Cylindrical grip0412
Pinch grip0118
Major movements359
Only41757

Thus, the proposed method in the rehabilitation of stroke patients, increase its efficiency due to the effects of the exercise of the imagination of movement on the neurophysiology of cortical motor representations. This increases the excitability of the motor cortex. We have developed a course of IMC - training improves the accuracy of the random activity of muscles in the limbs of patients with gross motor impairment after training using visual feedback. This allows you to actively included in musculoskeletal rehabilitation course IMC training, organized by the electroencephalogram and aimed at developing motor function recovery, especially in patients with ischemic stroke and with the GRU is s motor disorders.

The method of rehabilitation of patients after stroke, by training paretic limb, characterized in that the training carried out, showing a sick job on the imagination of movement of the paretic limb with the subsequent control of the imagination of movement of patients, based on the analysis of patterns in the electroencephalogram (EEG), arising from imagination of movement of the paretic limb, while the registration of EEG brain signals is performed with system active electrodes entsefalografa placed on the head surface, and transmit such data to a computer for their synchronous processing and separation of signals responsible for the perception of motion by using the classification of EEG patterns, Bayesian recognition results performed mental job placing the patient on a visual feedback in the form of labels on the screen to change which determine that the job is determined by comparing the parameters of the reaction of de-sensorimotor rhythm with those of the healthy subjects in the respective hemisphere during imagination of movement, and the job on the imagination of movement present in 10 seconds, the training paretic limb is 6-12 days, one workout a day, 20-30 minutes of interval and between training sessions from 1 to 4 days.



 

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2 tbl, 1 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pediatrics and can be used in neurology, medical psychology and psychiatry. Clinical examination of children is carried out by complaints, anamnestic information and data of physical examination. Assessed are: symptoms of vegetative manifestations at the moment of examination and peculiarities of sensomotor reactions: weight and length of body at birth, gestation age, response to stimulation in children of first year of life, sleep in children of first year of life, EEG in children of early age, parasomnia, enuresis, meteosensitivity, headaches, vessel lability, vestibulopathy, peculiarities of motor sphere, feeding behaviour, skin manifestations, course of infectious and somatic diseases, menstrual disorders in adolescent girls, brain ultrasound examination. Connection of said disorders with predominant dysfunction of right or left brain hemispheres is determined.

EFFECT: method makes it possible to increase reliability of diagnostics, which is achieved due to taking into account vegetative reactions and disorders in child of first year of life.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to oncologic neurosurgery, neurology, psychiatry and functional diagnostics. Electroencephalographic examination is carried out. Level of coherent connection between pole-frontal and anterior temporal regions of cerebral cortex on the right is calculated in beta-range. If said parameter is higher than 0.52, Korsakoff's syndrome is diagnosed.

EFFECT: method makes it possible to increase reliability of Korsakoff's syndrome diagnostics.

1 tbl, 2 ex

FIELD: medicine, neurology, psychopathology, neurosurgery, neurophysiology, experimental neurobiology.

SUBSTANCE: one should simultaneously register electroencephalogram (EEG) to detect the level of constant potential (LCP). At LCP negativization and increased EEG power one should detect depolarizational activation of neurons and enhanced metabolism. At LCP negativization and decreased EEG power - depolarized inhibition of neurons and metabolism suppression. At LCP positivation and increased EEG power - either repolarized or hyperpolarized activation of neurons and enhanced metabolism. At LCP positivation and decreased EEG power - hyperpolarized suppression of neurons and decreased metabolism of nervous tissue. The method enables to correctly detect therapeutic tactics due to simultaneous LCP and EEG registration that enables to differentiate transition from one functional and metabolic state into another.

EFFECT: higher accuracy of diagnostics.

5 dwg, 1 ex, 1 tbl

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