Nataliya A. Varako

Background. There is a high prevalence of impairments in executive functions in various neurological diseases (stroke, traumatic brain injury, neurodegenerative disorders), which severely limits patients’ independence and quality of life. The study integrates the theory of the systematic, step-by-step formation of mental actions and concepts by Galperin, Luria's approach to neuropsychology, and modern foreign rehabilitation techniques (e.g., strategies from the "Goal Management Training" program).

Objective. To assess the impact of a specialized neuropsychological training program on monitoring process indicators in patients with brain damage of various etiology. 

Design. The study involved 48 patients with brain damage of various etiology, aged from 23 to 74 years (M_age = 57.6; SD = 11.13; 17 women and 31 men). The patients were divided into an experimental group and a control group.

Results. A specialized training program aimed at improving monitoring process indicators in patients with impaired executive functions was developed, as well as a neuropsychological diagnostic protocol for assessing monitoring. We did not observe a training effect when comparing the monitoring index values before and after the training within the experimental group. However, we found significant differences between the experimental and control groups when analyzing the indices based on the results of the post-test assessment (U = 170, p = .008, p_bonferroni = .032), along with significant improvements in five monitoring indicators and the total Frontal Assessment Battery score in the patients of the experimental group.

Conclusion. The training effect, when comparing the experimental and control groups at the post-test, may be interpreted within the framework of intra-systemic semantic reorganization and the initial formation of a new mental action of selection and implementation of a solution in which monitoring actively participates. This interpretation is preliminary and requires further empirical validation. In future research, we plan to focus the training on the formation of the mental action of control.

Background. Currently, insufficient attention is being paid to methods of rehabilitation of patients with negleсt syndrome. It is necessary to create an effective way to overcome this condition.

Objective. After we developed and tested a specialized rehabilitation training program for patients with neglect syndrome, we sought to verify that the designed program would have a positive impact on the indicators of visuospatial search in these patients, in contrast to a control group. The patients underwent the specialized training, and improvements in the indicators of visuospatial search were observed, which minimized manifestations of left neglect.

Design. The study consisted of two stages: 1) the development and approbation of the author's task aimed at diagnosing visuospatial neglect syndrome, and 2) the development and approbation of the specialized rehabilitation training and evaluation of its impact on the indicators of visuospatial search in patients with neglect syndrome. Eighty-three patients with lesions of the right hemisphere of the brain took part in the first stage of the study; 37 patients with left-sided visuospatial neglect syndrome took part in the second.

Results. The results of the ANOVARM data analysis indicated statistically significant changes in the visuospatial search of the experimental group's patients. Specifically, there was an increase in the number of head turns to the left (F = 18.127, p<.05) and a decrease in the proportion of missed stimuli on the left (F = 18.367, p<.05). Additionally, the total time to complete the tasks presented by the author's methodology increased after participation in the specialized rehabilitation training. An increase in this indicator may suggest that patients in the experimental group were becoming more aware of the search process. There were no significant differences in the indicators of visuospatial search between patients in the two control groups.

Conclusion. After completing a specialized rehabilitation program to overcome left-sided neglect, patients with neglect syndrome demonstrated improved visuospatial search indicators and increased overall visual activity. The training also had non-specific effects, such as increased motivation, more engagement in the rehabilitation process, and more willingness to participate in other individual and group classes.

Background. Alexandria R. Luria’s classic neurorehabilitation methods (“restorative learning”) have now been successfully applied in clinical settings for more than seventy years. It is of interest how Luria’s methods relate to contemporary strategic approaches to effective rehabilitation. One such framework is the International Classification of Functioning, Disability and Health (ICF)—a comprehensive WHO framework for measuring health and disability for diagnostic and rehabilitation purposes.

Objective. To compare Luria’s procedure of restorative learning in aphasia and the ICF. Such a comparison may facilitate the use of the ICF in the work of multidisciplinary rehabilitation teams for diagnosis, planning, implementation, and evaluation of rehabilitation programs.

Design. A systematic comparison of ICF components with specific rehabilitation procedures developed by Luria aimed at speech understanding and production.

Results. Luria’s speech rehabilitation methods pertain to the ICF component “Body Functions and Structures”. Specific correspondences between Luria’s rehabilitation procedures and ICF categories are found, especially for afferent and efferent aphasias. For the aphasias related to speech understanding (sensory and semantic aphasia), such correspondences are rare. This reflects an insufficient differentiation in the understanding of higher cognitive functions in current neurorehabilitation. Luria’s concern for patients’ personality and social status is also explicated.

Conclusion. Although Luria’s “restorative learning” is realized within the ICF domain of “Body Functions and Structures”, his approach also focuses on the rehabilitation of the personal and social status of the patient. This approach is an important condition for clinical and psychological rehabilitation in the ICF domains of “Activities” and “Participation”.

Background. Contemporary rehabilitation of memory impairments relies on the use of external compensatory strategies. In Russian neuropsychological tradition, rehabilitation is understood as a transformation of a higher mental function, based on intact elements of that function and on use of external and internal means. Such a restructuration approach may be applied to memory. 

Objective. This article describes the basic principles underlying memory rehabilitation and gives an example of their successful implementation in a clinical case. 

Design. A 62-year-old patient was admitted 6 months after severe traumatic brain injury with primary damage to his le frontal and temporal lobes. He faced difficulties in social living and activities of daily life, mainly due to memory impairment. Neuropsychological assessment revealed moderate impairment of different memory types: modal nonspecific impairment with mild but persistent impairments in autobiographic and semantic memories. During a 3-week rehabilitation program, an algorithm involving the use of text was developed in consideration of the structure of memory impairment (impaired selectiveness, excessive inhibition and pathologic inertness of memory traces). 

Results. After multiple trials and modifications, the resulting algorithm (written retelling with the use of keywords, self-correction with writing correct variants instead of errors), allowed reproduction of the presented text with 100% recall of significant information and no false memories. The use of the developed memorization technique in everyday life allowed the patient to effectively memorize relevant information.

Conclusion. The described approach—restructuration of memory on the basis of preserved chains—is a feasible strategy of memory rehabilitation.