Modern therapeutic approaches to rehabilitation of patients after neurosurgical intervention

ern therapeutic approaches to rehabilitation of patients after neurosur-gical intervention. Cardiometry; Issue No. 30; February 2024; p. 92-97; DOI: 10.18137/cardiometry.2024.30.9297; Available from:

More than 13.8 million patients undergo neurosurgical procedures worldwide every year [1], which indicates the importance and necessity of such operations. However, like any other surgery, neurosurgical manipulations are associated with a fairly high risk, as well as with possible complications that may occur both in the postoperative period and in the recovery period of the patient.

After a neurosurgical operation, the patient may need a recovery period to return to normal life. Recovery depends on the nature of the operation, the affected structures, as well as the general health of the patient. An important aspect is the organization of strict medical supervision, which includes regular clinical examinations and examinations to keep any signs of complications under control. Physical rehabilitation includes exercises to restore strength, coordination and mobility. In addition, neurosurgical operations can have a psychological impact on the patient. Support from a psychologist or psychiatrist can be an important part of recovery. If the areas of the brain responsible for cognitive functions were affected during the operation, the patient may need rehabilitation to restore memory, attention and other cognitive skills.

In the process of rehabilitation of patients after neurosurgical intervention, the role of a therapist is extremely important, who can competently assess the physical and cognitive state, as well as the overall level of functionality. Based on this assessment, the therapist can develop an individualized rehabilitation plan, taking into account the needs and capabilities of the patient. The therapist plays a leading role in coordinating patient care by collaborating with other members of the medical team, including neurosurgeons, nurses, and other specialists.

In modern conditions, along with traditional means and methods of rehabilitation of patients after neurosurgical operations, the use of non-traditional methods of restoring health, such as art therapy, etc., as well as the achievements of information technolo- gy and artificial intelligence, is quite effective. All this makes it possible to speed up the rehabilitation process of patients, as well as improve their quality of life.

The purpose of the study is to consider modern therapeutic approaches to the rehabilitation of patients after neurosurgical intervention.

MATERIALS AND METHODS

In the process of writing the study, theoretical and practical approaches to the organization of the rehabilitation process of patients after neurosurgical intervention were studied, information from articles and monographs within the framework of the research topic was also summarized and analyzed. Comparative and analytical research methods have been used in writing the work.

RESULTS

Rehabilitation is defined by the World Health Organization (WHO) as a set of measures aimed at optimizing functioning and reducing disability in people with disabilities in interaction with the environment [2]. The field of rehabilitation is very wide, and people may need and benefit from rehabilitation services at any stage of their lives. Due to the increasing prevalence of noncommunicable diseases and the aging of the population, rehabilitation has become an important health strategy of the 21st century. Based on the 2019 Global Burden of Disease Study (GBD 2019), a recent study presented the first global estimates of rehabilitation needs, suggesting that the number of people who benefited from rehabilitation increased from 1.48 billion in 1990 to 2.41 billion in 2023.

After emergency treatment, patients with neurological disorders should be supervised by a specialized multidisciplinary team for the purpose of neurorehabilitation. Traditional rehabilitation methods may have limited effectiveness for patients with neurological disorders. Over the past decades, some key fundamental and clinical research has led to profound changes in neurorehabilitation interventions, which has made neurorehabilitation one of the main areas of research in the field of rehabilitation.

Modern approaches to the rehabilitation of patients who have undergone neurosurgery are diverse. Some experts note in this way the power of art, which is able to restore a person’s spiritual harmony, stabilize his relationship with the outside world and, thereby, stimulate the mechanisms of self-healing of the body.

Other researchers point out that there is no need to turn to information technology and artificial intelligence, arguing that modern rehabilitation practices are impossible without robotic technologies and high-tech practices. In our opinion, any innovations that are applied in rehabilitation practices and have an effect should be recommended for use, since the main purpose of their application is to help the patient improve the quality of life and restore health. To this end, it is necessary to consider the above-mentioned approaches to rehabilitation and analyze their possibilities in the field of restoring the health of patients after neurosurgical intervention.

Art as a way of healing is native to many cultures. Western societies have recently adopted the idea of using art for medicinal purposes [3]. Expressive Arts therapy (EAT) combines physical and psychological non-traditional methods. She uses art, music, dance and writing together with an experienced expressive arts therapist to help people navigate their experiences and emotions[4].

Music therapy has been studied in neurosurgical rehabilitation in Germany since the 90s. This study has aroused increased interest in neuromusicology. With the addition of modern research, new therapeutic strategies are being explored to improve the impact of music therapy on neurosurgical rehabilitation [5]. Given such promising results in the field of music as a therapeutic approach, expressive arts therapy should be applied and scientifically studied more widely, including during recovery from neurosurgical procedures.

Separate advantages of complementary medicine and EAT include their holistic approach and mindbody integration approach. Neurological research has shown that expressive art therapy uses a holistic approach to health that can potentially improve the overall quality of life. Art therapy after stroke improves the use of affected limbs and promotes concentration and communication, including social interaction and expression of emotions [6]. Patients also experience physical improvement in terms of fatigue, improved self-care and adherence to the treatment regimen.

The patient’s self-expression through art allows him to express emotions about the problems and pain of recovery. It can be difficult for patients to voice painful experiences, and EAT provides a different way of communicating. Dance allows patients to express themselves physically [7]. Art therapy allows patients

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to process and conceptualize their feelings by creating images [8]. Dramatic therapy is a powerful process of self–expression, self-discovery, personal growth and healing. Self-expression through art can clarify the patient’s recovery process and lead to more significant psychosocial benefits. Taking into account its features, EAT will provide neurosurgical patients with the best possible rehabilitation care.

Access to complementary medicine and EAT can be improved through telemedicine and mobile applications. Telemedicine and virtual technologies emerged during the development of the Covid-19 pandemic as tools to improve access to medical services. Examples of telemedicine use include virtual nutrition counseling, virtual yoga, and music therapy. Current mobile applications include patient nutrition tracking apps, music therapy, and mental health apps.

Experts note the positive results of the use of the technologies discussed above. For example, yoga improved balance and mobility in patients with chronic traumatic brain injury (TBI) [9]. Music therapy improved gait, upper limb function, decreased arousal, and improved orientation in stroke patients [10].

Mobile medical applications (apps) can also improve access to complementary medicine and EAT. In recent years, many nutrition and yoga apps have appeared. Music therapy applications can help in gait training for Parkinson’s disease, treatment of episodic migraines, and rehabilitation after stroke [11].

Within the framework of telemedicine, telerehabilitation has been developed, which can be defined as the provision of rehabilitation services using various technologies remotely. Experts note the positive impact of telerehabilitation, its ease of use and acceptability for the rehabilitation of patients after neurosurgical interventions. The literature also reports on the possibility of using a remote robotic telerehabilitation system. The researchers note high patient satisfaction and the absence of side effects. In addition, stroke patients gave high marks for the perceived usefulness and ease of using remote mobile rehabilitation systems at home.

Mobile technologies are used to quantify the quality of movement and provide feedback to improve upper limb rehabilitation and improve functional mobility in patients undergoing neurosurgery. It was also noted that the use of a mobile phone is possible for a self-help telerehabilitation program at home, integrated with the exoneuromuscular skeleton of the wrist and arm, controlled by electromyography, in patients who have undergone neurosurgical interventions [12].

Recent advances in telecommunications have facilitated the remote provision of rehabilitation services through the Internet of Things, messaging services, telephone, video conferencing and other means of communication technology. It is reported that in addition to the convenience and flexibility of telerehabilitation, it allows you to minimize problems such as nosocomial infections, fatigue and travel distance [13]. Telerehabilitation can also enhance the continuity of rehabilitation interventions, monitoring and home-based counseling for people who have undergone neurosurgery.

Discussion. In addition to mobile applications and telemedicine capabilities, advanced areas in the field of neurorehabilitation are being developed today. One such achievement is virtual reality (VR). VR can be described as a type of graphical user interface that displays a computer-generated immersive three-dimensional interactive environment that can be accessed and controlled, for example, using stereo headphones, head-mounted stereo television glasses and gloves for data transmission [14].

This is a promising computer technology that has recently emerged as an approach to neurorehabilitation and has become widely and rapidly applied in clinical settings. Patients receive multisensory stimulation and interact with computer games in an environment that looks and feels similar to objects and events in the real world. Modern virtual reality technology has the characteristics of immersion, interaction and imagination [15].

Compared with traditional approaches to therapy, VR technology has the following advantages in rehabilitation settings. First, VR gives patients the opportunity to practice everyday functions at home, thereby saving human and hospital resources. Secondly, VR encourages a large number of repetitions of exercises, because the games are interesting and the patients are motivated. Third, VR provides standardized and individualized training modes, making rehabilitation more accurate. Finally, VR can promote motor learning and neuroplasticity through immediate feedback when performing tasks [16].

Research on virtual reality technologies in neurorehabilitation focuses mainly on the following four aspects. Firstly, VR technology can effectively improve the motor functions of the upper limb and increase the range of motion of the shoulder, elbow and wrist. A review study involving 2,470 stroke patients in 72 clinical trials showed that VR intervention can be useful for improving upper limb function in combination with routine care [17].

Another group of specialists developed a system of “VR mirror boxes” and evaluated it in comparison with the classic installation of mirror boxes. The results of neuroimaging revealed a stronger activation in the primary sensorimotor cortex of the brain, contralateral to the actual movement in this condition, which suggests that VR mirror therapy may be superior to traditional mirror therapy to improve motor functions [18].

Another group of specialists developed an active individual therapy using a virtual keyboard system that surpassed occupational therapy in improving fine motor skills after a stroke.

Experts note that VR technology is useful for improving gait and balance functions. In particular, VR helps to improve balance and gait in all groups and can bring additional benefits in combination with traditional rehabilitation [19].

The literature also presents the development of an innovative treadmill platform based on immersive virtual reality, which was useful for improving the ability to walk in children with cerebral palsy. In addition, recent research shows that virtual reality technology has a beneficial effect on pain relief. For example, VR has been demonstrated to improve embodiment and reduce neuropathic pain caused by spinal cord injury [20]. Another case study reported that VR combined with hypnosis is superior to standard non-VR hypnosis in the treatment of chronic neuropathic pain [21].

Worldwide, VR technology has gradually become one of the traditional approaches to neurorehabilitation. However, the current use of virtual reality technologies in the field of neurorehabilitation in most clinics around the world is relatively limited.

Another development aimed at improving the efficiency of recovery of patients after neurosurgical intervention is rehabilitation robotics, a rapidly developing field in which applications are increasingly used in clinical settings [22]. Over the past decade, the field of rehabilitation robotics has made great progress due to the rapid development of science and technology and has gradually become an important means of neurorehabilitation.

Compared to traditional rehabilitation methods, rehabilitation robots have a number of advantages. First, a rehabilitation robot can reduce the physical burden on therapists and make rehabilitation more cost-effective. Secondly, the robot can adjust the training parameters to make rehabilitation treatment more accurate and flexible. Thirdly, the robot allows you to standardize training using objective data and feedback, which provides an objective and quantitative assessment of patient progress. Fourth, learning with robots can make learning more fun and improve patient compliance with treatment regimens. Finally, the use of robots is not limited to the place, and patients can undergo active rehabilitation at home.

Recent developments in the field of rehabilitation robots have focused on the use of “soft exoskeletons” or “exosuits” [23]. The specialists presented a neurobiotic architecture that combined prosthetic touch, grip kinesthesia and movement in bionic upper limbs to achieve more human functions with effective sensory-motor recovery. Using the three-dimensional printing approach, the experts presented soft robotics with natural and safe interaction between robotic devices and living organisms [24].

A marked improvement in clinical results was also confirmed in studies that examined the effectiveness of a robotic device using computer-assisted hand rehabilitation in people who have undergone neurosurgical interventions with upper limb weakness. In most studies that used robotic interventions, significant clinical results were recorded [25]. For example, a team of specialists has developed a portable soft robotic glove to support the grip and opening of the affected fingers of stroke patients while performing a wide range of functional tasks. The system was recognized as applicable, feasible and acceptable [26].

Noninvasive brain stimulation (NBS) is a new technology that allows neuromodulation to be applied in a focal, noninvasive, safe, repeatable and well–controlled manner. NBS technology can control and modulate the excitability of intracortical neural circuits, thereby contributing to the reorganization of neurons and increasing adaptive plasticity [27].

In addition, today, invasive neuromodulation is used in the rehabilitation of patients after neurosurgical intervention, in which deep brain stimulation, vagus nerve stimulation, peripheral nerve stimulation and surgical electrotherapy take place. Specialists reported a patient with paraplegia due to C7-T1 sub

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luxation who achieved full support on the leg and regained supraspinal control over some leg movements after undergoing special training with epidural stimulation. A recent large-scale randomized study showed that combined vagus nerve stimulation and rehabilitation training have a beneficial effect, improving the motor function of the upper extremities after ischemic stroke [28].

CONCLUSIONS

Rehabilitation after neurosurgical intervention combines traditional care with alternative physical, psychological and dietary approaches. EAT uses both physical and non-physical alternative therapy methods to help interpret one’s own emotions and those of others.

In the years since the Covid-19 pandemic, telemedicine and mobile apps have become tools to improve access to medical care. From a neurosurgical point of view, improving access to medical care primarily included the introduction of telemedicine, which includes treatment options related to nutrition, dietary supplements, yoga and other alternative therapies. In addition, mobile medical applications have become an effective way for patients to access adjuvant treatments, including nutrition, mental health, and music therapy.

Digital technologies used in the rehabilitation of patients after neurosurgical interventions are multimodal and systemic, including telerehabilitation, gamification, virtual reality, mobile technologies, sensors and robotics. Research shows that the introduction of digital rehabilitation at home, as support for the restoration of motor skills of the upper limb is feasible and acceptable for a user with high scores of perceived usefulness.