Combined non-invasive neuromodulation using transcranial direct current stimulation, motor imagery and action observation for motor, cognitive and functional recovery in cortico-basal degeneration: a single case study.

This case report presents a comprehensive assessment and therapeutic intervention using non-invasive motor cortex neuromodulation for a 70-year-old female patient diagnosed with corticobasal degeneration (CBD). The study followed the CARE guidelines. The patient meets the criteria for probable CBD, with neuroimaging evidence of exclusively cortical impairment. The patient underwent a non-invasive neuromodulation protocol involving transcranial direct current stimulation (tDCS) and action observation plus motor imagery (AO+MI). The neuromodulation protocol comprised 20 sessions involving tDCS over the primary motor cortex and combined AO+MI. Anodal tDCS was delivered a 2 mA excitatory current for 20 minutes. AO+MI focused on lower limb movements, progressing over four weeks with video observation and gradual execution, both weekly and monthly. The neuromodulation techniques were delivered online (i.e. applied simultaneously in each session). Outcome measures were obtained at baseline, post-intervention and follow-up (1 month later), and included motor (lower limb), cognitive/neuropsychological and functional assessments. Walking speed improvements were not observed, but balance (Berg Balance Scale) and functional strength (Five Times Sit-to-Stand Test) improved post-treatment. Long-term enhancements in attentional set-shifting, inhibitory control, verbal attentional span, and working memory were found. There was neurophysiological evidence of diminished intracortical inhibition. Functional changes included worsening in Cortico Basal Ganglia Functional Scale score. Emotional well-being and general health (SF-36) increased immediately after treatment but were not sustained, while Falls Efficacy Scale International showed only long-term improvement. The findings suggest potential benefits of the presented neuromodulation protocol for CBD patients, highlighting multifaceted outcomes in motor, cognitive, and functional domains.

[Effectiveness of neuropsychological rehabilitation in acquired brain injury (II): Executive functions, behavioural modification and psychotherapy, and the use of the new technologies]. / Efectividad de la rehabilitación neuropsicológica en el daño cerebral adquirido (II): Funciones ejecutivas, modificación de conducta y psicoterapia, y uso de nuevas tecnologias.

INTRODUCTION: The consequences of acquired brain injury include impairments in cognition, emotion and behaviour. Neuro-psychology provides techniques for treating these disorders, but it is still important to establish which of all the available tools are most effective for this purpose. DEVELOPMENT: This article reviews existing studies on the effectiveness of neuropsychological rehabilitation, focusing on those areas more often affected after acquired brain injury. The purpose of the article is to guide and orient neuro-psychological rehabilitation of these patients based on the strongest evidence available in the literature. In this second part, we will focus on the rehabilitation of executive functions, the behaviour modification, and psychotherapy applied in this area, as well as the application of new technologies. CONCLUSION: There is enough evidence to recommend the neuropsychological rehabilitation of executive functions, and the application of the above mentioned tools in patients with acquired brain injury.

[Effectiveness of neuropsychological rehabilitation in acquired brain injury (I): attention, processing speed, memory and language]. / Efectividad de la rehabilitación neuropsicologica en el daño cerebral adquirido (I): atención, velocidad de procesamiento, memoria y lenguaje.

INTRODUCTION: The consequences of acquired brain injury include impairments in cognition, emotion, and behaviour. Neuro-psychology provides techniques for treating these disorders, but it is still important to establish which of all the available tools are most effective for this purpose. DEVELOPMENT: This article reviews existing studies on the effectiveness of neuropsychological rehabilitation, focusing on those areas more often impaired due to acquired brain injury. The purpose of the article is to guide and orient neuro-psychological rehabilitation of these patients based on the strongest evidence available in the literature. This paper focuses on cognitive domains such as attention and neglect, memory and language. CONCLUSION: There is enough evidence to recommend the neuropsychological rehabilitation of the above processes in patients with acquired brain injury.