Anticipatory-prognostic regulation of motor functions in the rehabilitation training of patients after ischemic stroke (analysis of clinical cases)

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Abstract

Purpose. Evaluation of the effectiveness of anticipation-prognostic regulation in rehabilitation training of patients with ischemic stroke, taking into account the levels of movements’ construction and localization of the lesion.

Methods. 17 patients participated in the study (62.3±1.48 years). Based on the localization of the ischemic stroke focus, two groups were formed: the first group included 11 patients with localization of the ischemic stroke focus in the cerebellar structures. The second group consisted of 6 patients with lesions of the basal ganglia. The NIHSS scale was used to assess neurological status. Assessment of severity of motor disorders was carried out with the use of functional neuropsychological tests. The research included three phases: diagnostic phase (pre-diagnosis of gnostic and praxis functions); the stage of the rehabilitation training (using the hardware-software complex “Visual medicine”); the re-identification stage (estimated gnostic and praxis functions after rehabilitation training).

Results. As a result of the study, it was found out that in patients who suffered an ischemic stroke with localization of the lesion in the basal ganglia, the level of voluntary movements’ construction may transform into automated ones (without the possibility of automating motor programs). The implementation of motor programs in such patients is possible only through speech mediation at the level of voluntary movements’ construction.

Conclusions. In patients who have suffered an ischemic stroke with localization of the lesion in the structures of the cerebellum, at the level of voluntary movements’ construction both separate movements and motor programs are restored through speech mediation. In the absence of speech mediation, patients make mistakes mainly when performing separate movements that make up motor programs. This leads to a violation of the motor program. Due to morphological limitations, the automation of both separate movements and complete motor programs requires significantly more time. The implementation of motor programs is also possible for this category of patients at any level of movements’ construction on a basis of speech mediation.

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About the authors

Vera B. Nikishina

Pirogov Russian National Research Medical University

Author for correspondence.
Email: petrash@mail.ru
Russian Federation, 117997, Moscow, Ostrovityanova str., 1

Ekaterina A. Petrash

Pirogov Russian National Research Medical University

Email: petrash@mail.ru
Russian Federation, 117997, Moscow, Ostrovityanova str., 1

Tatyana V. Shuteeva

Kursk State Medical University

Email: petrash@mail.ru
Russian Federation, 305041, Kursk, K. Marks str., 3

Elizaveta I. Nikishina

I.M. Sechenov First Moscow State Medical University

Email: petrash@mail.ru
Russian Federation, 119146, Moscow, Bolshaya Pirogovskaya str., 19с1

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Supplementary files

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2. Fig. 1. Strategies for restorative learning of motor functions in patients with ischemic stroke through the mechanisms of anticipatory and prognostic regulation

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3. Fig. 2. Dynamics of recovery of indicators of the rate and accuracy of the prediction function at the sensorimotor level (“Labyrinth” method); letters denote test subjects' codes

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4. Fig. 3. Dynamics of recovery of indicators of the rate and accuracy of the forecasting function at the perceptual level (the "Tower of Hanoi" method); letters denote test subjects' codes

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5. Fig. 4. Dynamics of restoration of indicators of tempo and accuracy of an arbitrary level of organization of serial organization of movements; letters denote test subjects' codes

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Copyright (c) 2021 Nikishina V.B., Petrash E.A., Shuteeva T.V., Nikishina E.I.

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