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Transdisciplinary Team in Rehabilitation of Unconscious Brain-Damaged Persons: Grounds and Practice

Journal of Behavioral and Brain Science 2020年第8期10卷 323-343页

作者： Olga Maksakova ludmila zhavoronkova N.N.Burdenko National Medical Research Center of Neurosurgery Moscow Russia Institute of Higher Nervous Activity and Neurophysiology Russian Academy of Sciences Moscow Russian

The main features of early rehabilitation after severe brain damage are discussed in the article. The most important component for the entire rehabilitation process and the subsequent life of the patient is considered restoration of consciousness. Team seems to be a key factor in regaining consciousness along with the restoration of vital functions, movement, cognition, and behavior in these patients. The basic working principle is feedback to any minimal movement, or vegetative signal of a patient, beyond specific professional targets. A network of feedbacks with a patient and between professionals, that is, free flow of information, can be built only through work in a transdisciplinary team mode. The net of feedbacks with the patient and inter-professional ones builds up the team as Non-linear Complex System. Characteristics of “Team-Patient” system status are energy, entropy, and complexity. Teamwork techniques are individualized for resulting optimization of system condition. Increase of complexity is a powerful tool for propulsion of recovery process. Then consciousness may appear as a result of system self-organization. The article reflects the authors’ view on interdisciplinary studies of the phenomenon of consciousness through its impairment and recovery. It focuses on the work of the “proper rehabilitation team”, the mechanisms of its action and methods for researching the occurring phenomena.

关键词： Severe Brain Damage Unconsciousness Neurorehabilitation Team as Complex System Mind-Body Problem

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FMRI and EEG Reactions to Hand Motor Tasks in Patients with Mild Traumatic Brain Injury: Left-Hemispheric Sensitivity to Trauma

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Journal of Behavioral and Brain Science 2019年第6期9卷 273-287页

作者： ludmila zhavoronkova Sofia Moraresku Galina Boldyreva Elena Sharova Svetlana Kuptsova Alexander Smirnov Eugen Masherov Olga Maksakova Igor Pronin Institute of Higher Nervous Activity and Neurophysiology Russian Academy of Sciences Moscow Russia Lomonosov Moscow State University Moscow Russia Center for Speech Pathology and Neurorehabilitation Moscow Russia N.N. Burdenko National Medical Research Center of Neurosurgery Moscow Russia

Background: Mild traumatic brain injury (mTBI) is one of the most common forms of cerebral pathology in young people and disorders involve dysfunctions in cognitive and motor spheres. We would like to examine the structural and functional alterations of the brain in patients with mTBI while performing hand movements. Methods: Twenty healthy right-handed subjects (age 25.1 ± 3.9) and 10 patients (age 27.9 ± 7.3) with mTBI without hemiparesis participated in the study using functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). FMRI and EEG reactions were analysed during right- and left-hand movements. Results: It was shown that fMRI reactive changes have a larger inter-individual variability of activation during left-hand movements in comparison with right-hand ones in healthy subjects. The TBI patients demonstrated an increase of a diffuse component of fMRI reactive changes compared to healthy people. A greater number of the brain structures was involved, mainly at the subcortical level, mostly in the left hemisphere during right-hand movement. EEG study demonstrated coherence changes for the slow (delta) frequency bands in the left hemisphere, while performing both hand movements. In healthy persons, EEG coherence changes were observed in the fast (alhpa2) frequency band predominantly in contralateral hemispheres, while performing hand movements. Conclusion: So, fMRI and EEG studies revealed the most expressed pathological reactive changes in the left hemisphere and the brain cortical structures during right-hand movements in patients after mTBI. These data allowed us to propose that the younger brain structures were the most sensitive to mTBI.

关键词： fMRI EEG Traumatic Brain Injury Right- and Left-Hand Movements

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