Varako, N.A.

Background. The relevance of the investigation is associated with insufficient study of the dependence of rehabilitation outcome in patients with unilateral spatial neglect on the variant of neglect syndrome.

Objective. The purpose of this study is to describe polymodal signs and symptoms of neglect as well as their dynamics in patients who underwent rehabilitation in the first year after right hemispheric stroke.

Study Participants. 38 patients with left-sided neglect (24 men and 14 women aged 32 to 82) who underwent two rehabilitation courses within the first year after suffering a stroke in the right hemisphere.

Methods. Comprehensive neuropsychological assessment according to A.R. Luria, tests and tasks to identify symptoms of neglect in various sensory modalities and mental domains. The patients were examined twice: during the early recovery period (1–3 months after the stroke) and during the late recovery period (6–12 months).

Results. It has been shown that the severity of neglect in different modalities varies significantly. A statistically significant dynamics has been identified in the regression of neglect symptoms in the visual, auditory, and tactile modalities, while the motor and motor-bodily variants of neglect do not demonstrate significant regression when comparing the early and late recovery periods.

Conclusions. The study of dynamics in the neglect symptoms regression has practical significance for rehabilitation prognosis and for assessing the effectiveness of rehabilitation measures. The results showed that the regression of left-sided neglect manifestations is heterogeneous: the regression of visual neglect is more pronounced as compared to motor neglect. Discussing the dynamics of manifestations of unilateral spatial neglect helps to approach an understanding of the neuropsychological mechanisms of this phenomenon, and therefore to the true (rather than phenomenological) criteria for its classification.

Background. In contemporary psychology, there are practically no diagnostic techniques that are sensitive to the severity of visual neglect as a function of the structure of the visual field and its loading with stimuli that take this structure into account.

Objectives. The aim is to develop and approve a methodology that will enable the severity of manifestations of the neglect syndrome in the visual field to be analyzed, depending on its being structured and loaded with stimuli.

Study Participants. The study involved 50 respondents aged 29 to 75 years (Mage = 58.5; SD = 18.82; 14 women), patients with neurological disorders of various etiologies of the right cerebral hemisphere, including 30 patients with neglect syndrome.

Methods. The study was conducted using a comprehensive neuropsychological examination according to the scheme of A.R. Luria. This included an assessment of higher mental functions, the implementation of quantitative methods to evaluate neglect syndrome, and the utilization of the “Red Shapes” test. The test consists of three series, presented sequentially on a portable tablet. The series include a set of red-coloured geometric figures. The number of stimuli presented in the right half of the screen differs from series to series.

Results. The “Red Shapes” test aimed at diagnosing the syndrome of neglect in the visual sphere has been developed. The psychometric properties of the test were evaluated. The scales demonstrated a satisfactory level of consistency with regard to the identified figures on the left and the time of search (Cronbach’s α scores vary from 0.716 to 0.881). All test scales exhibited a non-normal distribution according to the Kolmogorov-Smirnov criterion (p < 0.001), with the exception of the time scale in series 3 (p = 0.2). The correlations and descriptive statistics of the scales are presented.

Conclusions. In order to investigate the syndrome of neglect in the visual sphere, a methodology is proposed which allows for the assessment of disorders in this sphere with varying degrees of structuredness and stimulus load in the visual field. The evidence obtained supports the reliability and validity of the methodology.

Background. The authors developed a specialized set of functional magnetic resonance imaging paradigms, based on data from general psychology, neuropsychology and previous studies, to diagnose the “covert cognition” phenomenon on a Russian-speaking sample of patients with chronic disorders of consciousness. Before using this set with patients, it is advisable to carry out testing on a group of healthy people with preserved consciousness in order to detect significant clusters of activation corresponding to paradigms and to assess their reproducibility at the individual level.

Objectives. The study is aimed at testing the proposed set of fMRI paradigms in order to detect the “covert cognition” phenomenon on a sample of healthy volunteers.

Study Participants. Sample included 10 healthy volunteers (3 men, 7 women, M = 44 years, SD = 17).

Methods. The study was performed on a magnetic resonance imaging scanner “Magnetom Verio”, “Siemens” with a magnetic field strength of 3 Tesla. The hierarchical set of nine passive and three active paradigms was presented to participants. Statistical analysis was carried out using SPM12.

Results. As a result of group analysis, significant clusters of activation were observed in six passive paradigms, covering the perception of tactile (“writing” a letter on the abdomen), auditory non-speech (alarm clock, two musical fragments without words) and speech stimuli. Auditory speech paradigms (audio fragment from the film with obscene language, testee`s name within the “cocktail party” effect) were the most reproducible paradigms at the individual level.

Conclusions. The obtained results allow us to apply the proven paradigms in further studies to detecting the “covert cognition” phenomenon on a Russianspeaking sample of patients with chronic disorders of consciousness. Data on brain activation in healthy volunteers in different paradigms enriches theoretical understanding of cerebral organization of cognitive functions.

Relevance. Neuropsychological rehabilitation and assessment are the priority tasks in practice of a clinical psychologist. The modern rehabilitation system can be considered as a partnership between patients, their families and different specialists participating in the rehabilitation process. The existing approaches to neurorehabilitation are aimed at the earliest possible intervention. It`s of particular importance for patients with disorders of consciousness, whose number has been increasing in connection with the development of medicine in recent decades. This leads to the need to develop tools for specialized neuropsychological assessment and methods of neuropsychological rehabilitation of patients in the early stages of recovery of consciousness.

Objective. To summarize neuropsychological diagnostic and rehabilitation experience of working with patients with disorders of consciousness after brain lesions.

Methods. We analyze practical guidelines, applied research and our own hands-on experience of working with patients with disorders of consciousness after brain lesions.

Results. Based on the analysis, the recommended diagnostic tools are formulated that can be used to identify the current level of consciousness and to assess various parameters of psychic activity of patients with disorders of consciousness. In addition, the main directions and neuropsychological methods of rehabilitation work recommended for recovery of consciousness and continuing to be developed now are highlighted.

Conclusion. A new diagnostic and rehabilitation material is presented, which is recommended for use in neuropsychological practice by practicing clinical psychologists with patients with disorders of consciousness after brain lesions.

Acknowledgments: we would like to express our great appreciation to Professor Galina Ivanova, also Valentina Bykova and Olga Maksakova for comments that greatly improved the manuscript.