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Project titleDeveloping an approach to cognitive rehabilitation for ischemic brain damage using multitasking in virtual reality

Research area 05 - FUNDAMENTAL RESEARCH IN MEDICINE, 05-309 - Restorative medicine, physical therapy, balneology, physiotherapy

Keywordscognitive rehabilitation, virtual reality, immersive environment, multitasking, cerebral ischemia, neurophysiological mechanisms, digital electroencephalography, BDNF, NSE, protein S100

Annotation
The project is aimed to solve the fundamental interdisciplinary problem of neurophysiology and personalized medicine: the development of a new scientific approach to cognitive rehabilitation in ischemic brain damage using multitasking and modern immersive technologies, in particular virtual reality. The fundamental substantiation of the developed approach will be made on the basis of the study of the organization of functional brain systems underlying the recovering potential of virtual reality technology with the help of modern highly informative methods: high resolution electroencephalography with analysis of standardized low resolution brain electromagnetic tomography - sLORETA, extended computerized cognitive status evaluation and analysis of markers of neurovascular unit (neuronspecic enolase, neurotrophic factor of brain) as well as the application of modern methods of intelligent analysis of arrays of multi-parametric clinical, psychometric and neurophysiological data.

Expected results
It is expected to obtain priority fundamental results that will provide an understanding of the neurophysiological mechanisms of recovery of cognitive functions under the influence of cognitive training with the simultaneous execution of motor and cognitive tasks in virtual reality in ischemic brain damage in the performance of the project. An important step of the project will be to determine the level of recovery potential of virtual reality technologies for cognitive rehabilitation in ischemic brain damage using changes in the electrical activity of the cerebral cortex and a comprehensive indicator of cognitive status. It is planned to carry out an analysis of the brain activity topography features associated with the simultaneous performance of motor and cognitive tasks in virtual reality using modern methods of data mining, which will allow us to establish the most informative indicators that reflect the recovering process of cognitive functions. Based on the data which we obtained earlier and the analysis of the literature, we suggest that the use of a rehabilitation approach based on the use of multitasking training with the simultaneous execution of motor and cognitive tasks in virtual reality can be effective in ischemic brain damage. Due to the fact that the disseminated nature of brain tissue damage in cerebral ischemia associated with cardiac surgery was previously established, the use of programs for recovering cognitive functions using virtual reality technologies and multitask approach can, on the one hand, expand cognitive resources when included in the performance of varied tasks of a larger volume of brain tissue, and, on the other hand, activate the processes of neuroplasticity and start a compensatory restructuring of brain resources in response to an increased load. The choice of the object of study (patients with cerebral ischemia who underwent cardiac surgery), the relevance of the goal and the use of modern methods determine the high level of results comparable to the world level. As a result of the project, the understanding of the fundamental mechanisms of recovering cognitive functions, reorganization of the frequency-spatial activity of the brain under the influence of cognitive training with the simultaneous execution of motor and cognitive tasks in virtual reality will be expanded and deepened. The data obtained will expand the current understanding of the neurophysiological mechanisms of cognitive impairment in cerebral ischemia and will justify the use of virtual reality technologies and dual tasks in cognitive rehabilitation, which is important for developing a personalized approach to recovering cognitive functions in patients with cardiovascular diseases. For the first time, a cognitive training application specially developed for solving the tasks of the project will be created with the introduction of the double task method into the immersive environment, which is a breakthrough solution in the methodological support of cognitive rehabilitation in cardiovascular pathology. The obtained original results of the study will be put into practice when organizing rehabilitation treatment. Articles will be published in publications indexed by Web of Science and/or Scopus Q1 (total - 4) - "Frontiers in Aging Neuroscience", "Cognitive Science", "International Journal of Cardiology", "Dialogues in Clinical Neuroscience" indexed by Web of Science and/or Scopus (total - 3) - "BMC Neurosience", "Cardiology and Cardiovascular Surgery", "Journal of Neurology and Psychiatry aimed S.S. Korsakov, 1 patent application, 1 computer program registration certificate. The preparation of 2 candidate dissertations and 1 doctoral dissertation. The results of the project will be presented in reports at the leading specialized scientific symposia at the federal and international levels: European Society of Cardiology Congress 2023-2025, International Conference on Alzheimer's and Parkinson's Diseases 2023-2025, Russian Congress of Cardiovascular Surgeons 2023-2025, Russian Congress of Cardiology 2023 -2024, European Academy of Neurology Congress 2023-2025, World Congress of Psychophysiology 2023-2025.

Annotation of the results obtained in 2023
A review analysis of the latest literature data, presenting the results of the current trends in the use of virtual reality technologies in the cognitive rehabilitation of patients with cardiovascular diseases, allowed us to substantiate the implementation of multimodal tasks in cardiac surgery patients. Еspecially it has been emphasizing the need to influence the most vulnerable brain regions during surgical intervention. It has been demonstrated that complex stimulation of executive functions, working memory and attention can be ensured by including in cognitive training the visual modality tasks which require the selection of objects according to the instruction, their counting or memorization, motor activity and immersion of this activity in a natural virtual environment. It has been found that the most effective combination of dual task components to achieve optimal cognitive transfer in cardiac patients can be a combination of more complex motor tasks and cognitive tests, using parallel brain regions providing executive control, working memory and attention functions. The results of this study contribute to understanding the effectiveness of multitasking cognitive rehabilitation interventions and provide the basis for the subsequent implementation of cognitive rehabilitation in a virtual reality environment. In order to successfully develop the adaptation of the software of the system of cognitive rehabilitation for reproduction in the virtual environment, an analysis of the official registers of patents for inventions and patent searches on objects of intellectual property was conducted, associated with virtual cognitive rehabilitation systems. The article analyses literary data concerning peculiarities of transfer of three-dimensional environment into virtual environment. Based on this, recommendations for displaying the training in a virtual environment were formed. Based on the revealed features of the application of multimodal tasks in the virtual reality environment, an original scenario of cognitive training, including tasks, with simultaneous stimulation in visual modality, was developed. The original hardware and software has been created, requiring the selection and counting of objects according to the instruction, carried out simultaneously motor activity and immersion of this activity into a natural virtual environment and taking into account the developed requirements. After testing the hardware and software of the system of cognitive rehabilitation in the virtual reality environment, a list of technical details and additional requirements was created on the group of 25 practically healthy volunteer persons, implying the adaptation and development of training software, taking into account the perception of a group of healthy volunteers and patients with brain ischemia. The objectives and results of this scientific project correspond to the strategy of scientific and technological development of the Russian Federation in the direction of «Transition to Advanced Digital, Intelligent Production Technologies, Robotic Systems, New Materials and Design Methods, Creation of Systems for Processing Large Volumes of Data, Machine Learning and Artificial Intelligence»also correspond to the activity of the national program «Digital Economy of the Russian Federation» direction of virtual and augmented reality technology.

Publications

1. O.M. Razumnikova, O.A. Trubnikova Технологии виртуальной реальности для восстановления когнитивных функций и качества жизни: применение для кардиологических пациентов с ишемией мозга Комплексные проблемы сердечно-сосудистых заболеваний, - (year - 2023)

2. Tarasova I.V., Trubnikova O.A., Kukhareva I.N. Клинические аспекты применения технологий виртуальной реальности в когнитивной реабилитации пациентов с сердечно-сосудистыми заболеваниями. Сибирский журнал клинической и экспериментальной медицины, 38(3):32-36 (year - 2023) https://doi.org/10.29001/2073-8552-2023-39-3-32-36

3. Tarasova I.V., Trubnikova O.A., Kukhareva I.N., Syrova I.D., Sosnina A.S., Kupriyanova D.S., Barbarash O.L. A Comparison of Two Multi-Tasking Approaches to Cognitive Training in Cardiac Surgery Patients Biomedicines, 18;11(10):2023 (year - 2023) https://doi.org/10.3390/biomedicines11102823

4. - Программа когнитивной реабилитации для пациентов при ишемическом повреждении головного мозга -, 2023684523 (year - )