Sensorimotor Rehabilitation and Psychotherapeutic Techniques Effect on the Psychoemotional State in the Stroke Recovery Period

Abstract

INTRODUCTION. Stroke is the leading cause of disability of the population. In addition to motor disorders, cognitive and affective disorders contribute to the development of disability. The development of effective neurorehabilitation programs aimed not only at reducing the severity of motor deficits, but also at timely correction of psychoemotional disorders in stroke patients is very relevant for restorative medicine. In view of the proven positive therapeutic effect of physical exercises on anxiety and depression, their protective effect on cognitive functions, it is of interest to study the effect of motor rehabilitation on psychoemotional disorders in stroke patients. AIM. To study the effect of sensorimotor rehabilitation on affective and cognitive disorders in patients in the recovery period of stroke in comparison with a complex psychotherapeutic technique. MATERIALS AND METHODS. The study examined 2 groups of patients in the recovery period of ischemic stroke (up to 2 years) with the presence of anxiety and/or depressive disorders, comparable in gender, age, duration and focus of stroke localization, severity of neurological deficit. The 1st group — 24 patients — received a course of sensorimotor rehabilitation without targeted impact on affective disorders; the 2nd group — 25 patients — a course of complex medical and psychological adaptation lasting 18 days. The effectiveness of rehabilitation was assessed using validated scales and questionnaires (Rivermead Mobility Index, 6-point muscle strength assessment scale, modified Ashfort spasticity scale; Berg balance scales, Beck depression, Spielberger-Khanin anxiety, MMSE, MoCA; Schulte Table Methodology, SS-QOL Stroke Quality of Life Assessment Scale). Statistical analysis was carried out using the StatTech v. 2.8.8 program (developed by Stattech LLC, Russia). RESULTS AND DISCUSSION. The preliminary assessment carried out in both groups showed a twofold predominance of anxiety states over depressive ones, concomitant cognitive impairments were detected in 88 % of patients, among whom attention disorders were most often recorded (there was no intergroup difference in these indicators). After completing the course of both sensorimotor and medico-psychological rehabilitation, both groups showed a significant decrease in the level of situational and personal anxiety on the Spielberger-Khanin scale, positive dynamics on the MoСа scale, the SS-QOL questionnaire, while a significant decrease in the level of depression on the Beck scale was registered only in patients of the 2nd group on against the background of the use of specialized psychotherapeutic techniques. CONCLUSION. Motor rehabilitation is positively comparable with complex medical and psychological adaptation, it affects anxiety and cognitive functions in patients with ischemic stroke, it can be considered as one of the effective ways to correct anxiety states and prevent cognitive impairment in these patients, while in the treatment of depression the priority is should be given to specialized medical and psychological intervention.