Psychomotor disorders in patients with the consequences of a brain stroke in the late period of rehabilitation

Authors:

Oleg L. Belyanin, leading researcher of Department of biomechanical research of the musculoskeletal system of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: belynin.oleg41@bk.ru; http://orcid.org/0000-0001-6019-8053.

Elena O. Gordievskaya, PhD in Pedagogical sciences (PhD Ped. Sci.), Associate Professor, senior researcher of the Department of professional and psychological rehabilitation of disabled persons of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: elena.gord@bk.ru; https://orcid.org/0000-0002-7617-298X.

Annotation:

Introduction. The possibility of quantitative assessment of the state of psychomotor properties and functions of disabled people due to acute cerebral circulation disorders in the long-term rehabilitation period is considered. This is necessary for their examination when changing the disability group, rational employment and socialization. After an acute violation of cerebral circulation, psychomotor properties and functions suffer first of all, which entails the loss of the ability to move, self-service and ability to work in 80 % of disabled people. As they recover, they recover, but not completely, and remain impaired to varying degrees and in distant terms from the debut. This reduces the effectiveness of rehabilitation and the quality of life of a disabled person. Therefore, all these disabled people require monitoring of psychomotor activity as the basis of vital activity with a quantitative assessment of the degree of violations, which is relevant for neurologists of the Bureau of Medical and Social Expertise.

Aim. The aim of the study is to determine the state of psychomotor functions of disabled people due to acute cerebral circulatory disorders in the late period of rehabilitation using instrumental testing methods and presenting the results in quantitative form to calculate the percentage of their decrease relative to the age and gender norm.

Materials and methods. 44 disabled people were studied due to acute ischemic cerebral circulation disorder aged 45 to 80 years with a debut of 17.3±2.3 years before the present study in the late rehabilitation period. All patients underwent comprehensive rehabilitation in specialized hospitals. At the time of the study, their condition was assessed as satisfactory. In the disabled with severe paresis, the study was conducted on the safe side, and in the rest on both. For testing, the software and hardware psychodiagnostic complex Multipsychometer-05 with automatic quantitative data processing, their tabular and graphical representation was used. The following battery of tests was used: sensorimotor reaction rate, tapping test, inter-extremity coordination test, motor tracking of the target test, multiple alternative choice test, dynamics of motor skill training test. The tests were presented without situational adaptation and stereotype development.

Results. An increase in reaction time due to the general inhibition of the disabled person is shown; a decrease in mobility and lability (increased inertia) of the processes of excitation and inhibition; a violation of the co-ordination of differentiated actions of the limbs; a violation of the correct orientation in the environment for quick decisionmaking, the development of an express program of adequate action and its implementation, which leads to a decrease in the accuracy and stability of the “covering” both static and dynamic goals; reduced stability and endurance to prolonged and intense dynamic load with a decrease in the rate of working into the rhythm of the load; progressive drop in speed with more time learning a new motor skill with a simultaneous increase in the required number of repetitions, an increase in the number of errors and a decrease in the effectiveness of activity; violations in a limited area of one hemisphere functionally affect the entire neurodynamics and psychomotor due to the diaschisis effect.

Discussion. The necessity of quantitative assessment of basic psychomotor functions with the use of objective instrumental methods and presentation of results in the form of a percentage decrease relative to the age and sex norm in the late rehabilitation period to determine restrictions on categories of vital activity is shown.

Conclusion. In all cases of testing, there was a decrease in their indicators relative to the norm, but not exceeding, however, 60 %, which corresponds only to a mild or moderate degree of violation of this psychomotor function. Despite the pronounced lateralization of motor disorders, psychomotor disorders affect the entire motor system in both hemispheres. The disability group is determined by the depth of the paresis and the entire neurological deficit of the patient.

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