Effects of dual-task rehabilitative training in the early postoperative period after direct myocardial revascularization

Aim. To assess the effects of cognitive rehabilitation with dual-task training that involves a cognitive task combined with postural and walking control, as well as electroencephalogram indices in patients in the early postoperative period after direct myocardial revascularization.

Methods. The study enrolled 48 patients scheduled for coronary artery bypass graft surgery. Subjects in this prospective, randomized study were randomized using envelopes to a postoperative cognitive training group (n = 23) and non-training group (n = 25). The cognitive training was carried out daily, starting 3-4 days after the procedure and until the discharge order. Dual tasks training (a cognitive task combined with postural and walking control) lasted 15-20 minutes. All patients were submitted to an extended neurophysiological assessment (psychometric tests and electroencephalogram study) and stabilography 3-5 days before and 8-11 days after coronary artery bypass grafting.

Results. The patients who underwent cognitive training experienced postoperative cognitive dysfunction (POCD) in 39% cases in the early postoperative period after intervention, while the non-training group - in 64%. The relative risk of developing POCD in the non-training group was 2.77 (95% CI: 0.86-8.91, Z = 1.704, p = 0.08). The patients in cognitive training exhibited better cognitive state compared to the preoperative state (Z = 2.58; p = 0.01) in the absence of statistically significant differences in the non-training group. Moreover, type-1 theta power values increased in the non-training group in comparison to the preoperative values, while the cognitive training group did not have a statistically significant difference in theta power.

Conclusion. Positive effects of dual task rehabilitation on the neurophysiological parameters of patients undergoing direct myocardial revascularization were demonstrated. Positive effects include lower frequency of POCD, improved cognitive state and less pronounced cortical dysfunction. The dual task training had proved a suitable training method for this category of patients. Additional studies are required to test the possibility of increasing the duration and intensity of dual task training for stronger recovery effect and improved cognitive and walking performance of patients in the postoperative period after direct myocardial revascularization.

1. Fraga F.J., Mamani G.Q., Johns E., Tavares G., Falk T.H., Phillips N.A. Early diagnosis of mild cognitive impairment and Alzheimer's with event-related potentials and event-related desynchronization in N-back working memory tasks. Comput Methods Programs Biomed. 2018;164:1-13. doi: 10.1016/j.cmpb.2018.06.011.

2. Beppi C., Ribeiro V.I., Scott G., Sandrone S. EEG, MEG and neuromodulatory approaches to explore cognition: Current status and future directions. Brain Cogn. 2021;148:105677. doi: 10.1016/j.bandc.2020.105677.

3. van den Berg E., Geerlings M.I., Biessels G.J., Nederkoorn P.J., Kloppenborg RP. White Matter Hyperintensities and Cognition in Mild Cognitive Impairment and Alzheimer's Disease: A Domain-Specific Meta-Analysis. J Alzheimers Dis. 2018;63(2):515-527. doi: 10.3233/JAD-170573.

4. Zhavoronkova L.A., Maksakova O.A., Shevtsova T.P., Moraresku S.I., Kuptsova S.V, Kushnir E.M., Iksanova E.M. Dual-tasks is an indicator of cognitive deficit specificity in patients after traumatic brain injury. S.S. Korsakov Journal of Neurology and Psychiatry 2019;119(8):46-52. (In Russian). doi:10.17116/jnevro201911908146

5. Trubnikova O.A., Tarasova I.V, Barbarash O.L. Neurophysiological mechanisms and perspective for the use of dual tasks in recovering cognitive function after cardiac surgery. Fundamental and Clinical Medicine. 2020:5(2): 101-111. (In Russian). doi:10.23946/2500-0764-2020-5-2-101-111

6. Moreira J.M.A., Grilo E.N. Quality of life after coronary artery bypass graft surgery - results of cardiac rehabilitation programme. J Exerc Rehabil. 2019;15(5):715-722. doi: 10.12965/jer. 1938444.222.

7. Relander K., Hietanen M., Rantanen K., Ramo J., Vento A., Saastamoinen K.P., Roine R.O., Soinne L. Postoperative cognitive change after cardiac surgery predicts long-term cognitive outcome. Brain Behav. 2020;10(9):e01750. doi: 10.1002/brb3.1750.

8. Tarasova I.V, Trubnikova O.A., Kupriyanova D.S. Cognitive rehabilitation of cardiac surgery patients: problems and prospects. Siberian Medical Review. 2020; (5):23-30. (In Russian). doi: 10.20333/2500136-2020-5-23-30

9. Borghini G., Astolfi L., Vecchiato G., Mattia D., Babiloni F. Measuring neurophysiological signals in aircraft pilots and car drivers for the assessment of mental workload, fatigue and drowsiness. Neurosci Biobehav Rev. 2014;44:58-75. doi:10.1016/j.neubiorev.2012.10.003

10. Sidorovich Je.K., Lihachev S.A., Klishevskaja N.N., Pavlovskaja T.S. Rezul'taty trenirovki postural'noj i kognitivnoj funkcij u pacientov s hronicheskimi ishemicheskimi narushenijami mozgovogo krovoobrashhenija s primeneniem staticheskoj i dinamicheskoj stabiloplatform. Nevrologija i nejrohirurgija. Vostochnaja Evropa. 2015; 1 (25): 69-78. (In Russian)

11. Petrigna L., Thomas E., Gentile A., Paoli A., Pajaujiene S., Palma A., Bianco A. The evaluation of dual-task conditions on static postural control in the older adults: a systematic review and meta-analysis protocol. Syst Rev. 2019 Jul 27;8(1):188. doi: 10.1186/s13643-019-1107-4.

12. Chu C.H., Yang K.T., Song T.F., Liu J.H., Hung T.M., Chang YK. Cardiorespiratory fitness is associated with executive control in late-middle-aged adults: an event-related (de) synchronization (ERD/ERS) Study. Front Psychol. 2016; 7: 1135. doi: 10.3389/fpsyg.2016.01135.

13. Muir-Hunter S.W., Wittwer J.E. Dual-task testing to predict falls in community-dwelling older adults: a systematic review. Physiotherapy. 2016;102(1): 29-40. doi:10.1016/j.physio.2015.04.011.

14. Ansai J.H., Andrade L.P., Rossi P.G., Almeida M.L., Carvalho Vale F.A., Rebelatto J.R. Association between gait and dual task with cognitive domains in older people with cognitive impairment. J Mot Behav. 2018;50(4):409-415. doi:10.1080/00222895.2017.1363702.

15. Kleiner A.F.R., Souza Pagnussat A., Pinto C., Redivo Marchese R., Salazar A.P., Galli M. Automated mechanical peripheral stimulation effects on gait variability in individuals with Parkinson disease and freezing of gait: a double-blind, randomized controlled trial. Arch Phys Med Rehabil. 2018. pii: S0003-9993(18)30355-1. doi:10.1016/j.apmr.2018.05.009.

16. Commandeur D., Klimstra M.D., MacDonald S., Inouye K., Cox M., Chan D., Hundza S.R. Difference scores between singletask and dual-task gait measures are better than clinical measures for detection of fall-risk in community-dwelling older adults. Gait Posture. 2018;66:155-159. doi:10.1016/j.gaitpost.2018.08.020.

17. Erdoes G., Rummel C., Basciani R.M., Verma R., Carrel T., Banz Y, Eberle B., Schroth G. Limitations of Current NearInfrared Spectroscopy Configuration in Detecting Focal Cerebral Ischemia During Cardiac Surgery: An Observational Case-Series Study. Artif Organs. 2018;42(10):1001-1009. doi: 10.1111/aor. 13150.

18. Tarasova I.V, Trubnikova O.A., Syrova I.D., Akbirov R.M., Barbarash O.L. Long-term results of the neurophysiological examination of patients with cognitive decline underwent coronary artery bypass surgery. Nevrologicheskiy Zhurnal (Neurological Journal) 2018; 23 (5): 229-240 (In Russian). doi:10.18821/1560-9545-2018-23-5-229-240.

19. Trubnikova O.A., Kagan E.S., Kupriyanova T.V, Maleva O.V, Argunova Y.A., Kukhareva I.N. Neuropsychological status of patients with stable coronary artery disease and factors affecting it. Complex Issues of Cardiovascular Diseases. 2017; (1):112-121. (In Russian) doi: 10.17802/2306-1278-2017-1-112-121

20. Trubnikova O.A., Tarasova I.V, Barbarash O.L., Barbarash L.S. Structure and frequency of detection of cognitive decline in patients after direct myocardial revascularization. Creative cardiology. 2015; 4: 5-12. (In Russian). doi: 10.15275/kreatkard.2015.04.01

21. Moretti DV. Electroencephalography-driven approach to prodromal Alzheimer's disease diagnosis: from biomarker integration to network-level comprehension. Clin Interv Aging. 2016;11:897-912. doi: 10.2147/CIA.S103313.

22. Benwell C.S.Y, Davila-Perez P., Fried P.J., Jones R.N., Travison T.G., Santarnecchi E., Pascual-Leone A., Shafi M.M. EEG spectral power abnormalities and their relationship with cognitive dysfunction in patients with Alzheimer's disease and type 2 diabetes. Neurobiol Aging. 2020;85:83-95. doi: 10.1016/j.neurobiolaging.2019.10.004

23. Schumacher J., Taylor J.P., Hamilton C.A., Firbank M., Cromarty R.A., Donaghy P.C., Roberts G., Allan L., Lloyd J., Durcan R., Barnett N., O'Brien J.T., Thomas A.J. Quantitative EEG as a biomarker in mild cognitive impairment with Lewy bodies. Alzheimers Res Ther. 2020;12(1):82. doi: 10.1186/s13195-020-00650-1.