PAPELES DEL PSICÓLOGO Vol. 39-2 Mayo - Agosto 2018

A r t i c l e s 155 Papeles del Psicólogo / Psychologist Papers, 2018. Vol. 39(2), pp. 155-160 he problem of restoring consciousness after various cerebrovascular pathologies is particularly acute in modern clinical practice, since the quality of the subsequent restoration of mental activity correlates with the duration of the unconscious state (Aleksandrova et al., 2013). Due to that there is a continuous search for predictors affecting the contraction of the depression of consciousness and its course for the further prognosis. According to the World Health Organization (WHO, 2015), diseases associated with disorders of the cerebral circulation are one of the leading causes of death in the world, and the number of deaths caused by them has a trend to a significant annual growth. There is a certain “rejuvenation” of these diseases - up to 30% of apoplectics today are people of working age (Vereshchagin, Varakin, 2001; Gusev et al., 2003). In terms of the number of apoplectics, Russia holds one of the first places in the world (Zaharov, Vahnina, 2011). Despite the positive dynamics compared to previous decades (Suslina, Varakin, 2009), our country is still the leader in the number of cases of stroke progression, as well as adverse consequences of this disease (Prokaeva et al., 2015). With the progression of stroke, the risk of the depression of consciousness is very high (Paciaroni et al., 2012), and the progression of an extreme degree of the depression of consciousness - coma - often ends in a fatal outcome. The fact of the depression of consciousness and its depth are important predictors of the severity of the course and outcome of a stroke, which directly determines the degree of efforts of various specialists in the rehabilitation of apoplectics (Negovskiy, 1977; Acciarresi et al., 2006; Lan et al., 2006; Litvickij, 2010). In order to illustrate the problem, a pilot retrospective research (analysis of the case histories) was conducted on the basis of the City Clinical Hospital No. 31 in Moscow in the Department of Neurologic reanimation. Case histories of 112 patients with a diagnosis of “acute cerebrovascular accident” were selected (Table 1). Among them were 54 patients with the depression of consciousness and 58 patients without it. Patients with severe concomitant diseases were not included at the group which could have a significant impact on the parameters of oppression of consciousness and act as predictors of death (pneumonia, cancer) to reduce the risk of side mixing. Patients had as comorbidities were obesity (6%), diabetes mellitus (13%), hypertension (94%) and atrial disease (13%) (patients may have several comorbidities). CLINICAL AND PSYCHOLOGICAL APPROACH TO THE REHABILITATION OF PATIENTS IN A STATE OF THE DEPRESSION OF CONSCIOUSNESS AFTER SUFFERING A STROKE Kovyazina M.S. 1,2 , Fomina K.A. 1 , Moskvin V.V. 1 , Varako N.A. 1,2 and Zinchenko Yu. P. 1 1 Lomonosov Moscow State University, Faculty of Psychology . 2 Research Center of Neurology, Department of rehabilitation and physiotherapy En este artículo se aborda el carácter interdisciplinario del problema de la conciencia. Se abordan cuestiones sobre la rehabilitación de pacientes con disminución de la conciencia. Se aporta el fundamento teórico de los enfoques de la psicología clínica sobre métodos consistentes en la estimulación de sistemas de analizadores. El artículo indica que las características del ictus puede determinar parámetros específicos del descenso de la conciencia. Se han obtenido datos estadísticos significativos sobre la relación entre el descenso del nivel de conciencia y la lateraoización y el tipo de ictus. En conclusión, los autores abordan cuestiones relacionadas con la aplicación de estimulación multimodal en la rehabilidación de la conciencia. Palabras clave: Psicología clínica, Conciencia, Disminución de la conciencia, Rehabilitación, Estimulación multisensorial. The interdisciplinary character of consciousness problem is emphasized in the article. The questions rehabilitation of patients with consciousness oppression are addressed. The theoretical background of clinical psychological approach to methods consisting of analyzers systems stimulation, which are used at the rehabilitation of patients with consciousness depression, is provided. The article shows that the stroke characteristics can determine the specific parameters of consciousness depression. Statistically significant data are obtained for a links between the depth of consciousness oppression and stroke lateralization or stroke type. In conclusion, authors outline the issues related to the application of multimodal stimulation in consciousness rehabilitation. Key words: Clinical psychology, Consciousness, Depression of consciousness, Rehabilitation, Multisensory stimulation. Received: 10 December 2017 - Accepted: 8 February 2018 Correspondence: M. S. Kovyazina. Professor of Department of Neuropsychology and Abnormal Psychology, Faculty of Psycho- logy by Lomonosov Moscow State University, corresponding member of the Russian Academy of Education. Moscow, Russian Federation, Mytischi, Beloborodova street, 11-2-145, 141006 Moscow. E-mail: T