Modern educational technologies for continuous post-stroke rehabilitation system

Фотографии: 

Dr.Hab., Professor G.N. Ponomarev1
PhD, Associate Professor J.E. Firileva1
1Herzen State Pedagogical University of Russia, St. Petersburg

Keywords: educational technologies, continuous rehabilitation, conceptual basis, practical and process technology components, physical, psychological, cognitive, communicative rehabilitation.

Introduction. An educational technology is a trend in pedagogy aimed to improve the educational and training process. Every educational technology is a system focused on the training outcome, which can be planned and achieved in strict compliance with the technology.
It can be concluded that educational technologies for continuous rehabilitation are an orderly system of rehabilitation measures, the persistent implementation of which guarantees the planned result, goal being achieved [7].
Objective of the study was to substantiate modern educational technologies for continuous post-stroke rehabilitation system, with a special emphasis on their design basics, and determine the possibilities of their application for increasing the level of motor activity of post-stroke patients.
Methods and structure of the study. The educational technologies for post-stroke patients mainly tend to restore lost body functions and systems, i.e. they are geared towards continuous rehabilitation.
The design basics of the educational technology for continuous rehabilitation include three parts: conceptual framework; practical content of the continuous post-stroke rehabilitation process; and the process technology as such.
The conceptual framework provides a scientific and theoretical basis for the continuous rehabilitation, specifically of man’s adaptive capabilities. The nervous system is the first to respond to the stimuli affecting the body. And it is only the endocrine system that contributes to its further interaction with the rest of the bodily functional systems. Being an important integration component, the endocrine system, for its part, is under the controlling impact of the nervous system, although in the process of adaptation it can precondition a series of reflex responses [2, 5].
According to the P.K. Anokhin’s concept (1975), adaptation is associated with the activation of a large number of compensatory mechanisms in various functional systems of the human body, aimed to retain vital constants of its internal environment. The assertion that any protective (adaptive) function can be actively stimulated based on the study data on changes in the functional systems involved in the compensatory processes is directly related to the problem of adaptive capabilities of the human body, in particular, through systematic training.
From the point of view of physiology, the essence of training is in the process of adaptation of the human body to the changed conditions associated with regular physical exercises. During systematic training, owing to the bodily responses occurring under the influence of external and internal factors, unconditioned reflexes and conditioned-reflex reactions are being improved. They contribute to both due process of formation and improvement of motor skills and enhancement of the functional capabilities of the body as a whole [3, 4].
At the same time, neither of the forms of compensation and adaptation can be developed out of activity, exercise, or training. Physical training is the most important stimulus for the development of adaptive reactions of the body, improvement of its adaptive properties. If the bodily functions change or become distorted, physical training helps achieve a significant compensatory adjustment.
The practical component includes the educational technology objective and missions plus the rehabilitation methods and tools customizable to the individual needs and specifics of every person in need of the post-stroke rehabilitation. The educational technology for continuous post-stroke rehabilitation primarily aims to regulate the system of rehabilitation tools, analyze their interaction and potential improvement of the intended results.
The practical component of the educational technology is based on continuous rehabilitation including all associated components of psychological, physical, cognitive and communicative rehabilitation.
Psychological rehabilitation is based on the methods of motivational stimulation, psycho-regulation of emotional state, art therapy, and music therapy.
Physical rehabilitation is based on the means of therapeutic, breathing, adaptive, joint, and segmental gymnastics, relaxation exercises, balance exercises, exercises to develop stability of vestibular reactions and fine motor skills, massage and self-massage.
Cognitive rehabilitation is based on such mental processes as: memory, attention, and thinking.
Communicative rehabilitation is based on such functions as: speech, vision and hearing.
All the continuous rehabilitation tools were duly harmonized by the motor coordination and musical illustration components. It was the first time the motor rhythm of a therapeutic movement was ever used in combination with the musical rhythm as a conjugate method of post-stroke rehabilitation treatment [6].
The process technology component is designed to secure the continuous post-stroke rehabilitation process with its models, educational and rehabilitation process control and management elements in the post-stroke rehabilitation period.
The continuous rehabilitation models include various types of stationary treatment: hospital, specialized clinic, polyclinic, rehabilitation center and home-based rehabilitation.
The study was performed in six health clinics in Saint Petersburg and Leningrad region in the period of 2014 to 2017, with a total of 248 patients sampled for the study.
The post-stroke rehabilitation treatment is divided into several periods: acute, first, second and adaptive rehabilitation periods. When managing the rehabilitation process, it is the pedagogical control data that are provided for reference, with the program-methodical support of continuous rehabilitation being corrected when required.
Results and discussion. The findings demonstrate that individual psychoemotional status can be improved by means of the targeted increase of motivation and setting him for a conscious and active restoration of the lost functions. The problem was solved using the means of psycho-regulation, ideomotor training and self-hypnosis. All of them gave significantly positive results. The physical rehabilitation processes proved the basic upper and lower limb movements, postures of sitting, standing and walking to be difficult to restore. Here, the entire educational technology complex was applied, the program-methodical support tools were distributed according to plan, as well as more specific and individual work was carried out with the patients, which were proved beneficial.
The analysis of the cognitive indicators revealed that post-stroke patients had the following mental process disorders: memory, attention and thinking problems. Nevertheless, consciousness and perception were normal in this category of people and there was practically no evidence of dementia.
The analysis of the communicative indicators in the post-stroke patients revealed numerous changes in their verbal function, mainly aphasias. If there were minor changes, speech was restored rather quickly. If the verbal malfunction was serious, a long-term treatment was required, with the active involvement of speech therapist and aphasiologists.
The degree of post-stroke visual disturbances depends on the severity of the brain tissue injury. In any case, it is necessary to ensure qualified ophthalmic care, as well as consider the state of other bodily functions.
According to modern statistical data, diminished hearing is one of the most common consequences of a stroke. Its main form is perceptive hearing loss. The questionnaire survey and observation methods showed that, in most cases (almost 90%), post-stroke patients were hearing-impaired, but ignored that fact.
The developed program-methodical support system makes it possible to apply the tools and methods of cognitive and communicative rehabilitation in the process of medical-educational control of specialists.
Conclusion. Educational technologies were found to be among the key structural components of the continuous post-stroke rehabilitation system as they reveal the essence of the rehabilitation process in its dynamics and make it possible to increase the level of motor activity of post-stroke patients.

References

  1. Anokhin P.K. Ocherki po fiziologii funktsionalnykh sistem [Essays on Physiology of Functional Systems]. Moscow: Meditsina publ., 1975, 447 p.
  2. Bekhtereva N.P. Zdorovy i bolnoy mozg cheloveka [Healthy and diseased human brain]. Leningrad: Nauka publ., 1980, 208 p.
  3. Motylyanskaya R.E., Stogova L.I., Iordanskaya F.A. Fizicheskaya kultura i vozrast [Physical education and age]. Moscow: Fizkultura i sport publ., 1967, 280 p.
  4. Pavlov I.P. Dvadtsatiletiy opyt ob'ektivnogo izucheniya vysshey nervnoy deyatelnosti (povedeniya) zhivotnykh [Twenty years of experience in objective study of higher nervous activity (behaviour) of animals]. Col. works: In 6 vol. 2nd ed., sup. Moscow-Leningrad: AS USSR, 1951, vol. 3, vol. 1, pp. 253-274.
  5. Sechenov I.M. Refleksy golovnogo mozga [Reflexes of the brain]. Moscow: AS USSR publ., 1961, 100 p.
  6. Firileva J.E. Adaptivny fitnes v neyromotornoy reabilitatsii cheloveka [Adaptive fitness in neuromotor rehabilitation in man]. Moscow: ANS publ., 2015, 250 p.
  7. Firileva J.E., Ponomarev G.N. Strukturnye komponenty pedagogicheskoy sistemy nepreryvnoy reabilitatsii pri insulte. [Structural components of educational system of continuous rehabilitation in stroke]. Mater. III Vseros. nauch.-prakt. konf. 'Fizicheskaya reabilitatsiya v sporte, meditsine i adaptivnoy fizicheskoy kulture' [Proc. III nat. res.-pract. conf. 'Physical rehabilitation in sports, medicine and adaptive physical education']. June 16-17 2017. St. Petersburg: PU publ., 2017, pp. 27-30.  

Corresponding author: firilevaze@yandex.ru

Abstract
The study analyzes benefits of modern educational technologies for a continuous post-stroke rehabilitation system, with a special emphasis on their design basics including the following: conceptual framework; practical content of the continuous post-stroke rehabilitation process; and the process technology as such. The conceptual framework provides a basis for the continuous post-stroke rehabilitation process geared to mobilize the individual adaptive capabilities with the relevant nervous and hormonal factors as the process control mechanisms. Practical content spells out the educational technology objective and missions plus the rehabilitation methods and tools customizable to the individual needs and specifics of every person in need of the post-stroke rehabilitation. The educational technology should be designed with a due priority given to physical, mental, cognitive and communicative tools of the modern continuous post-stroke rehabilitation system, with all the tools duly harmonized by the relevant motor coordination and musical illustration components. And the process technology component is designed to secure the continuous post-stroke rehabilitation process with its models, educational and rehabilitation process control and management elements in the post-stroke rehabilitation period.
The study was performed in six health clinics in Saint Petersburg and Leningrad region in the period of 2014 to 2017, with 248 patients sampled for the study. The study data and analyses showed benefits of the modern educational technologies for the continuous post-stroke rehabilitation system.