Нейрореабилитация пациентов со зрительным неглектом: нарративный обзор эволюции идей от А.Р. Лурии до современных клинических протоколов

ВВЕДЕНИЕ: В когнитивной нейропсихологии разработаны различные методы реабилитации пациентов с синдромом неглекта. Вместе с тем в луриевской нейропсихологической реабилитации этот вопрос не находился в центре внимания.

ЦЕЛЬ: Сопоставить пути восстановления высших психических функций, предложенные А.Р. Лурией, с современными подходами когнитивной реабилитации пациентов с левосторонним пространственным игнорированием, в основе которых лежат представления о восходящих (bottom-up) и нисходящих (top-down) процессах внимания.

МЕТОДЫ: Поиск работ проводили в электронных базах данных PubMed, Scopus, Web of Science, eLIBRARY.RU за период с 1984 по 2024 г. Источники включали в обзор, если в них присутствовали сведения о техниках преодоления левостороннего зрительного неглекта и оценке их эффективности. При отборе публикаций тип исследования не учитывали.

РЕЗУЛЬТАТЫ: На основе анализа 56 исследований, включенных в обзор, впервые сопоставили методы реабилитации левостороннего неглекта и путей восстановления высших психических функций в концепции Лурии. Результатом стала ревизия систематики восстановительных подходов с выделением нового направления, ориентированного на расширение/коррекцию возможностей ведущей афферентации функциональной системы (направленная коррекция).

ЗАКЛЮЧЕНИЕ: Ни один из существующих методов преодоления левостороннего зрительного неглекта не является лидирующим по своей эффективности. Наилучшие результаты показывают методы, направленные на перестройку функциональной системы и опирающиеся на произвольность и опосредованность, что во многом соотносится с нисходящими процессами внимания (top-down).

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