STUDY OF THE EFFICIENCY OF MOTOR-COGNITIVE TRAINING AS PART OF THE REHABILITATION PROGRAM FOR ELDERLY WOMEN WITH DEMENTIA AND THE CONSEQUENCES OF RADIUS FRACTURE

Abstract

Purpose – to evaluate the effectiveness of the use of cognitive-motor training as part of the developed rehabilitation program based on the dynamics of indicators that characterize hand motility, the cognitive and psychoemotional state of elderly women with dementia with the consequences of an osteoporotic fracture of the distal metaepiphysis of the radius in the post-immobilization period. Methods. 82 elderly women were examined. The control group consisted of 23 uninjured women. The comparison group consisted of women with a fracture of the radial bone, without signs of dementia, who received rehabilitation according to the appropriate protocol. The main group 1 consisted of women with a similar fracture, dementia, who received rehabilitation according to the corresponding protocol. The main group 2 consisted of women with a fracture, dementia, who received rehabilitation according to the developed program (therapeutic exercises, functional training, “MAPS THERAPY”; PNF; mobilization of the radiocarpal joint; massage of the upper limb; kinesiological taping; training in the «ReHand» application, strategies of compensatory and restorative cognitive training) lasting 2 months. Performance was assessed by Box and Block Test, Montreal Assessment Cognitive Rating Scale, Digit Span, Trailmaking test, Benton test, Symbol Digit Modalities Test, Geriatric Depression Scale, Multidimensional Fatigue Inventory, Life- Satisfaction Questionnaire-11. The results. In the examined injured women with dementia, impaired fine motor skills and dexterity of the injured upper limb (according to the Box and Block Test), decreased cognitive functions (according to the Montreal Assessment Cognitive Rating Scale), deterioration of verbal short-term memory (according to the Digit Span test), impaired flexibility of thinking and speed of information processing (with the Trail making test), visual memory and reproduction impairment (according to the Benton test), decreased speed of mental processes (according to the Symbol Digit Modalities Test). The psycho-emotional state of women was characterized by psycho-emotional depression (according to the Geriatric Depression Scale), physical and mental asthenia, decreased motivation (according to the Multidimensional Fatigue Inventory, МFI-20), worsening of life satisfaction (according to the Life-Satisfaction Questionnaire-11). The motor, cognitive, and psychoemotional state of women with dementia was statistically significantly worse for the studied indicators than with a normal mental status (p<0.05). The application of the developed rehabilitation program, developed with the use of cognitive-motor training and modern physical therapy methods, demonstrated a statistically significantly better result in all studied parameters of hand motility, neuro-psychological and psycho-emotional state (p<0.05) compared to the group that was engaged in general recommendations of the clinical protocol for the treatment of fractures of the bones of the forearm. Conclusions. The application of the rehabilitation program for elderly women with the consequences of a fracture of the radial bone and dementia, created taking into account the presence of a cognitive defect and its correction by means of cognitive-motor training, showed its effectiveness in the form of a significant improvement in relation to the initial result of the studied indicators and the results of a standard rehabilitation program.