Cybernetic Enriched Environment for Cognitive Rehabilitation
Anna Bezdenezhnykh, Semen Prokopenko, Elena Mozheyko, Vladidmir Salmin,
Alla Salmina and Yulia Komleva
Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky,
Partizana Jeleznyaka Street, Krasnoyarsk, Russia
1 BACKGROUND
Cognitive impairments in older adults is an
important medical and social issue. 83% of people
over the age of 60 complain of memory decrease.
Cognitive decline is observed in 69% of the elderly
on neuropsychological examinations. Most common
causes of cognitive impairments are neuro-
degenerative diseases and vascular cognitive
impairments. Vascular cognitive impairments are
revealed in 10% of cases in individuals from 70 to
90 years old. Post stroke cognitive disorders are
observed in 30-70% of patients and they decrease
rehabilitation outcomes and disease prognosis. In
one year, mild cognitive impairments progress to
Alzheimer disease in 10-15% of patients.
Along with drug therapy, there is active search
for effective methods of rehabilitation and
prevention of cognitive disorders worldwide.
Cognitive rehabilitation includes correction and
compensation approaches.
The purpose of correction is remediation of
damaged cognitive functions in patients. As a rule,
correctional medical training is performed by a
neuropsychologists. An alternative method can be
computer cognitive training (Prokopenko, 2013). In
both cases, training sessons are time-constraint and
the main principle of neurorehabilition – continuity
– is failed to abide.
The aim of all compensatory approaches is
increasing patients’ adaptation, independence and
safety in daily-life and decreasing their caregivers’
burden. There are a lot of compensatory strategies,
e.g. using diaries, cue cards, smart phones, pager
systems. Recentlu a lot of studies in the area of
cognitive rehabilitation investigate systems that are
based on the smart home technology. These systems
are aimed to facilitate patients’ daily life via
simplifying their interaction with electric and other
devices by these appliances’ automation. For
example, the light turns on and off automatically due
to motion sensors, the fridge can order food from a
shop, the timer reminds of the time to take
medications in. By so doing, the smart home
minimizes patient’s responsibility for satisfaction of
his or her needs and forces him or her to follow a
more passive lifestyle.
On the flip side, it has been proved in
experimental studies that enriched environment
produces a wide spectrum of indifferent and
unconditional stimuli. Modeling of enriched
environment is studies with experimental animals
for studying of effects of more massive sensory
physical, social and cognitive stimulation in
comparison with conventional environment.
Experimental studies with animals have shown that
multi-stimuli environment restores damaged
neurogenesis, apoptosis and and synaptogenesis,
protein expression of astroglial contacts, improves
training and memorization, maintains effective
social interaction including both cases of
physiological ageing and animal models of
Alzheimer disease. It corresponds with observations
of people with higher cognitive reserve which
resulted from their profession or personal habits.
Therefore, enriched environment exerts positive
influence on neuroplastic processes, saving and
restoring dominant mechanisms of brain’s function
realization (Kuvacheva, 2015).
The main hypothesis for using enriched
environment for neurorehabilitation is that different
permanent stimuli can activate reserve capacity of
brain and form new connections. Otherwise
speaking, if a patient with cognitive impairments is
accommodated in the setting, where he has to solve
cognitive tasks, it might improve his or her cognitive
state and/or prevent induction of cognitive deficit.
2 OBJECTIVES
Development of a new proprietary method for
cognitive rehabilitation based on Cybernetic
Enriched Environment and assessment of its
efficiency.
Bezdenezhnykh, A., Prokopenko, S., Mozheyko, E., Salmin, V., Salmina, A. and Komleva, Y.
Cybernetic Enriched Environment for Cognitive Rehabilitation.
In Extended Abstracts (NEUROTECHNIX 2016), pages 9-10
Copyright
c
 2016 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
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3 METHODS
The study was conducted in a Neurorehabilitation
Centre. Patients were exposed to Cybernetic
Enriched Environment for 30-40 minutes daily for
10 days.
3.1 Intervention Methods
At the present time an experimental model of the
Cybernetic Enriched Environment has been
developed. It is a chamber that imitates patient’s
living environment. There are different domestic
appliances: a kettle a microwave oven, a hairdryer, a
TV-set etc. in the chamber. All the appliances are
linked to a personal computer through an electric
relay. The patient has to perform a computer task to
turn on any of these appliances. The patient cannot
use the device until he or she solves the task
correctly. Computer tasks are represented by
proprietary neuropsychological computer programs.
Each of them is aimed to train different cognitive
domains: memory, attention, visual gnosis and other.
This computer complex of neuropsychological
programs had already shown effectiveness in
cognitive impairment restoration in post stroke
patients in acute and recovery periods. In Cybernetic
Enriched Environment conditions, only a part of the
whole program is presented to the patient when he
or she is required to switch on a particular appliance.
In that way, using different appliances, a patient has
to solve different tasks. Levels of task complexity
can be regulated individually.
3.2 Examination Methods
On admission, all patients were examined by a
neurologist, an internist, a physiotherapist and a
neuropsychologist. Laboratory and instrumental
examinations were conducted. Before (1) and after
(2) training course quantitative assessment was used
for examination of neurological, cognitive, affective
and functional states: Montreal Cognitive
Assessment (MoCA), Mini Mental State
Examination (MMSE), Frontal Assessment Battery
(FAB), Clock Drawing Test (CDT), Shulte’s Tables,
Hospital Anxiety and Depression Scale (HADS),
Instrumental Activity of Daily-Living (IADL),
National Institute of Health Stroke Scale (NIHSS),
Global Impression Scale of Patient and Clinician
(GISP, GISC).
4 RESULTS
A clinical case. Patient N. was admitted to the
rehabilitation center with the following diagnosis:
Ischemic stroke in the left middle cerebral artery
circulation with mild right-sided hemiparesis,
massive cognitive impairments in the late recovery
period. She was 63 years old and complained of
memory decrease which developed after stroke.
On extended qualitative neuropsychological
examination (Luria A.) bilateral dysfunction of
frontal lobes was observed. Patient N. was apathetic
with executive function disorder and secondary
memory decrease. On quantitative assessment score
decrease was observed on every neuropsychological
scale.
Table 1: Patient’s N. results before and after training.
Exa M MM F C Sh IA HA G G
min o SE A D ult D DS I I
atio C B T e L S S
n A P C
1 7 19 7 5 86 12 14/5 2 2
2 14 22 7 8 69 15 4/4
After Cybernetic Enriched environment training
course there were improvements on all neuropsycho-
logical scales beside FAB (Table 1). Patient N.
became more motivated and her voluntary attention
improved; she could regulate her activity better during
memory tasks.
5 DISCUSSION
The first experience of using of the Cybernetic
Enriched Environment for cognitive rehabilitation has
shown effectiveness and high prospects for this
method despite the fact that the experimental model
does not provide permanent stimulation yet. We
expect to obtain better results using the pre-
production model, in which the patient will be
exposed to cybernetic enriched environment for 24
hours a day during a long period of time. Randomized
control trials are required.
REFERENCES
Prokopenko, S., Petrova, M., Koryagina, T., Kaskaeva, D.,
Chernykh, T., Shvetzova, I., Bezdenezhnih, A., 2013.
Journal of the Neurological Sciences.
Kuvacheva, N., Morgun, A., Komleva, Y., et al., 2015.
Bull Exp Bio Med.
NEUROTECHNIX 2016 - 4th International Congress on Neurotechnology, Electronics and Informatics
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