Cognitive impairment in neurosurgical pathology of the brain is an urgent problem of modern neurorehabilitation. The involvement of computer-assisted technologies in rehabilitation medicine is effective and economically viable.

The rehabilitation concept with the use of computer-aided neuroimaging techniques was developed on the basis of functional systems theory by P.K. Anokhin and the principles of neuroevolution theory by G. Edelman. P.K. Anokhin understands function as an activity aimed at achieving a holistic result, which requires neurons of the brain to form new connections. Formation of a new functional system results in learning [1]. Formation of new functional systems during learning is based on selection of neurons from the reserve. The neuroevolution theory suggests that neurons are cognitively or behaviorally specialized; functioning neurons compete for a binding site, and the competition mechanism underlies the formation of functions [1,2].

The advantages of rehabilitation training using the computer-aided neuroimaging technique are increased accuracy of measuring and recording task results [3], affordability and low labor intensity of the rehabilitation procedure, reproduction of task results and performance analysis throughout the rehabilitation period, independent maintenance of rehabilitation results by patients in remote access conditions (out of hospital).

The Habilect complex is a label-free system for diagnostics and rehabilitation. The doctor gets an assessment of balance, gait, joint stress, as well as a biofeedback rehabilitation suite with augmented reality and motivational games without any sensors on the patient's body or platform. Habilect fulfills its tasks at each stage of the rehabilitation process: diagnostics, developing a training regimen, monitoring the correct performance of exercises, monitoring the patient's independent work at home between visits to the doctor, evaluating the effectiveness of prescribed therapy, and reporting throughout the rehabilitation process. Its goal is to ensure restoration of the patient's motor and cognitive functions through regular exercises and BFB.

The goal of this research is to evaluate the effectiveness of the Habilect program for cognitive rehabilitation of neurooncological and vascular patients.

Among the studied group, 33 patients (19 male and 14 female, average age 58.35±14.75 years) had nontraumatic intracranial hemorrhage, and 38 were operated for brain tumor (20 female, 18 male, average age 54.38±15.27 years). To evaluate the effectiveness of computerized programs for cognitive rehabilitation, a group of 38 patients was recruited (11 were operated for vestibular schwannoma, 7 for meningioma, 2 for astrocytoma, 11 for hypertensive hemorrhages, 7 for aneurysmal hemorrhages), who, in addition to traditional sessions with neuropsychologist, used the personal computer with Habilect complex, which facilitates functional active rehabilitation through visualization process. The control group included 33 patients (10 operated for vestibular schwannoma, 8 for meningioma, 8 for hypertensive hemorrhages, 7 for aneurysmal hemorrhages) who were treated individually and in small groups with a neuropsychologist. The research findings were processed with Statistica 10 (Stat Soft, USA) using median (Me) and quartiles (25%, 75%). The Mann-Whitney U-test served as the significance test. The design of the research makes it possible to evaluate the effectiveness of combining innovative and traditional methods of rehabilitation.

The mean MMSE score in the Habilect patient group was 25.25 (20.25; 27.0) at admission and 28.0 (25.75; 28.75) at discharge, with a dynamics indicator of 2.5 (1.50; 4.0) points. The mean FAB score was 14.5 (12.25; 15.0) at admission and 17.25 (15.0; 18.25) at discharge, with a dynamics indicator of 2.75 (2.0; 3.0) points. The mean score on the Roschina scale was 24.0 (17.0; 25.0) at admission and 15.0 (12.0; 22.0) at discharge, with a dynamics indicator of 4.0 (3.0; 6.0) points.

The mean MMSE score in the control group was 25.5 (20.75; 27.25) at admission and 28.5 (24.75; 29.0) at discharge, with a dynamics indicator of 2.75 (1.0; 4.25). The mean FAB score at admission was 15.0 (11.25; 16.75) and at discharge was 17.5 (16.75; 18.0); the dynamics indicator was 2.25 (1.0; 3.25) points. When tested on the Roschina scale, the mean score at admission was 17.75 (14.5; 24.0) and at discharge - 12.5 (10.25; 15.75); with the dynamics indicator being 5.0 (3.25; 8.25) points. No statistical differences (p>0.05) were found when comparing the dynamics indicators with those of the control group patients.

Table 1 details the findings of the Roschina scale for patients who participated in the Habilect program.

Habilect is a group of patients who participated in the Habilect program.

Table 1: Cognitive status dynamics of Habilect patients and control group patients as assessed against the Roschina Scale.

Note: *mean, mean-square deviation.

Habilect is a group of patients who participated in the Habilect program.

Control – Control Group

In the Roschina test, the Habilect group and the control group showed no statistically different dynamics when performing the following tasks: memorizing 9 words, delayed reproduction, solving an arithmetic problem, series subtraction, memorizing 10 words, updating knowledge from the past, memorizing 9 words with a common feature (p>0.05). The use of the program allowed statistically significant improvement in the dynamics for the following tasks: drawing 3 geometric shapes (U=97.5, p<0.01), arranging the clock hands (U=43.5, p<0.05), visual memory test (U=58, p<0.05). Thus, the Habilect program contributed to the recovery of visual and spatial gnosis, spatial praxis, short-term visual memory, that is, the higher cortical functions that operate with visual images. Current virtual technologies provide opportunities to use three-dimensional models in cognitive rehabilitation, which are more illustrative than classic neuropsychological aids. Accordingly, the correction of thought disorders requires careful, personalized selection of tasks with a specific focus and level of difficulty, and in this case, classical sessions with a neuropsychologist are more appropriate.

Table 2 shows the cognitive status dynamics of patients of different ages who participated in the Habilect program.

Table 2: Cognitive status dynamics of patients of different ages who participated in the Habilect program and patients of the control group.

Note: Habilect is a group of patients who participated in the Habilect program.

Control – Control Group

Table 2 shows that for young patients the combination of Habilect program with classical neuropsychological correction was statistically more effective than separate sessions with a neuropsychologist (for Roschina dynamics indicators U=27.5, p<0.05). At middle age and elderly age, the results in the main and control groups were comparable (p>0.05 for all dynamics indicators).

Table 3 shows the cognitive status dynamics of patients with varying degrees of cognitive impairment who participated in the Habilect program.

Table 3: Cognitive status dynamics of patients who participated in the Habilect program and patients of the control group with varying degrees of cognitive impairment.

Note: Habilect is a group of patients who participated in the Habilect program.

Control – Control Group

Table 3 shows that the use of Habilect program was statistically effective among patients who scored 28-30 on the MMSE scale at admission (for Roschina test dynamics indicators U=6, p<0.01). Patients with pre-dementia cognitive impairment (24-27 MMSE scores) responded slightly better to computer-assisted rehabilitation than to standard techniques, although such differences were not statistically significant (for all test dynamics indicators, p>0.05). In observations with mild to moderate dementia, the use of Habilect had no effect on the outcome of cognitive rehabilitation (p>0.05). Patients with severe impairments of higher cortical functions are characterized by fast exhaustion when performing tasks, which requires an individual approach in choosing a pace and sequence of exercises. Therefore, patients with severe cognitive deficits often do not understand the tasks assigned to them by the program. Thus, computerized programs can be an adequate addition to sessions with a neuropsychologist only for mild cognitive impairment.

Control – Control Group

Table 4 shows the cognitive impairment dynamics of patients with different forms of neurosurgical pathology who participated in the Habilect program.

As shown in Table 4, the results of cognitive rehabilitation using the Habilect program and separate use of classical neuropsychological correction methods were comparable for both types of neurosurgical pathology (p>0.05). Thus, the nature of neurosurgical pathology does not play a significant role in the choice between classical and computer-based techniques of cognitive rehabilitation.

Table 4: Cognitive impairment dynamics in patients who participated in the scientific brain training PRO program and in patients of the neuropsychological correction group with different types of neurosurgical brain pathology.

Note: Habilect is a group of patients who participated in the Habilect program.

Contemporary literature quite often evaluates the possibility of supplementing or even replacing methods of classical neuropsychological correction with computer-based programs. Their use would allow, on the one hand, to spend public funds more efficiently and, on the other hand, to ensure continuity and consistency of rehabilitation of higher cortical functions at the inpatient and outpatient stages [4,5]. The present research evaluated the effectiveness and feasibility of Habilect computer-based program combined with traditional neuropsychological correction for cognitive rehabilitation of neurosurgical patients. In the group of patients who used computer technology, the integral index of the Roschina test dynamics was 4.0 (3.0; 6.0) points and did not statistically differ from that in the control group (p>0.05). A detailed analysis considering the structure of cognitive impairments revealed that the use of Habilect significantly improved the test results for spatial and visual gnosis, spatial praxis, short-term visual memory, i.e. higher cortical functions operating with visual images (p<0.05). The lowest dynamics values of the Roschina test were observed in elderly patients engaged in the Habilect program (3.5 (1.25; 4.5) points, statistically less than in other age groups, p<0.05) and in patients with mild (3.0 (2.0; 4.5) points) and moderate (3.75 (3.0; 7.0) points) severety. Patients with severe cognitive deficit are characterized by increased exhaustion during exercise [6,7]. This requires an individual approach when choosing the sequence and pace of the tasks presented. In addition, computer techniques do not finely differentiate tasks by the level of complexity depending on the patients' needs [7,8]. Therefore, patients with severe cognitive impairment often do not understand the tasks assigned to them. Thus, computerized programs can be an adequate addition to sessions with a neuropsychologist only for mild or moderate cognitive impairment. Academic literature contains little information about the influence of age on the results of computer-assisted cognitive rehabilitation programs [9,10]. In this regard, the mind-set of Russian patients should be taken into account. Elderly patients in our country are not always experienced users of a personal computer, and this complicates the use of computer programs for their rehabilitation. Regardless of the applied techniques, the rehabilitation measures should result in an improvement in the patient's quality of life [11].

Thus, current computer-assisted rehabilitation methods are not a viable alternative to traditional sessions with a neuropsychologist for patients with cognitive impairment. Computerized programs are advisable as an additional rehabilitation method in young patients with mild to moderate impairments of higher cortical functions, especially in the area of spatial gnosis and praxis.

Ivanova Nataliya Evgenyevna

http://orcid.org/ 0000-0003-2790-0191

Efimova Maria Yuryevna

http://orcid.org/ 0000-0002-0145-8211

Samochernykh Konstantin Aleksandrovich

https://orcid.org/0000?0003?0350?0249

Dikonenko Mikhail Viktorovich

http://orcid.org/ 0000-0002-8701-1292

Conflict of Interest

The authors declare that there is no conflict of interest.

Financing

Studies were supported by the State Assignment of the Ministry of Health of Russia ? 39.

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