Effects of home-based physical exercise programs on cognition in older adults: an integrative review / Efeitos de programas de exercícios físicos domiciliares na cognição de idosos: uma revisão integrativa

This study sought to review randomized clinical trials of home-based physical exercises and their effects on cognition in older adults. An integrative review was carried out after searching the PubMed, Google Scholar, MEDLINE, LILACS, SciELO, and PEDro databases. The risk of bias of the included randomized controlled trials was assessed using the PEDro Scale. Fourteen studies were included, with an average PEDro score of 6.1±1.7 (range, 3 to 9) points. Overall, the studies found that interventions consisting of home-based physical exercise programs, whether strength training alone or combined with aerobic and balance exercises, performed three times a week in 60-minute sessions for a minimum duration of 8 weeks, contribute to cognitive performance in older adults, with particular impact on executive function. We conclude that home-based physical exercises constitute a strategy to minimize the negative implications associated with cognitive impairment in older adults

Este estudo buscou revisar ensaios clínicos randomizados com exercícios físicos domiciliares e seus efeitos na cognição de idosos. Foi feita uma revisão integrativa com seleção nas bases de dados PubMed, Google Scholar, MEDLINE, LILACS, SciELO e PEDro. A avaliação do risco de viés dos ensaios clínicos randomizados incluídos foi feita usando a Escala PEDro. Catorze estudos foram incluídos, cuja pontuação dos artigos na escala PEDro foi em média de 6,1±1,7 pontos, com a pontuação total variando de 3 a 9. De forma geral, os estudos apontaram que a intervenção com programas de exercícios domiciliares de treino de força isolado ou combinado com exercícios aeróbio e de equilíbrio, realizado três vezes na semana com 60 minutos por sessão e duração mínima de oito semanas, contribui para o desempenho cognitivo de idosos, especialmente sobre a função executiva. Concluiu-se que exercícios domiciliares se apresentam como uma estratégia para minimizar as consequências negativas associadas ao déficit cognitivo em idosos

Habilitación de funciones frontales básicas en cardiópatas congénitos a través de LEGO® Education / Basic frontal functions qualification in congenital heart disease with LEGO® Education

Las cardiopatías congénitas se consideran una de las anomalías que alteran la irrigación y el intercambio de oxigenación adecuado a las principales venas y arterias. Esto puede generar consecuencias en el desarrollo neurológico que se puede traducir en retraso psicomotor, déficits de aprendizaje, dificultades académicas y problemas de integración social. Para mejorar los trastornos cognitivos, se propone la habilitación cognitiva basada en los principios de mecánica y robótica de LEGO® Education. El objetivo de este estudio fue medir el efecto de un programa de intervención, basado en el uso de ensamblado y programación robótica con LEGO® Education, sobre las funciones frontales básicas como primera aproximación a un modelo propuesto en pacientes cardiópatas congénitos que han sido sometidos a cirugía cardiovascular. Se trató de un estudio de serie de casos, en el que finalizaron el tratamiento una niña y dos niños con cardiopatías congénitas con RACHS 2 y 3. Se aplicaron sub-escalas BANFE-2 y el cuestionario neuropsicológico de daño frontal antes y después del tratamiento; así como una escala para medir el nivel de ejecución por intervención, durante las ocho sesiones. Los resultados muestran en la escala BANFE2, cambios en las medias de las funciones frontales básicas, de daño leve-moderado y normal a normal alto, principalmente en memoria de trabajo y fluidez verbal. En esta primera aproximación, el método LEGO® Education mostró ser una buena herramienta para la habilitación neuropsicológica de estos pacientes.

Congenital heart diseases are considered to be an anomaly which alter the irrigation and the adequate exchange of oxygenation to the main veins and arteries. They can have neurodevelopmental consequences that could translate into psychomotor retardation, learning deficits, academic difficulties, and social integration problems. Cognitive empowerment based on the mechanics and robotics principles of LEGO® Education is proposed to improve cognitive disorders. In this study, the objective was to measure the effect of an intervention program, based on the use of assembly and robotic programming with LEGO® Education, upon basic frontal functions as a first approach to a proposed model in congenital heart disease patients who have undergone cardiovascular surgery. This was a case-series study, in which a girl and two boys with congenital heart disease with RACHS 2 and 3, completed the treatment. BANFE-2 subscales and the neuropsychological questionnaire of frontal damage were applied before and after the treatment; as well as a scale to measure the level of performance per intervention, through all the eight sessions. The BANFE-2 scale showed changes in the means of frontal functions, from mild-moderate damage and normal to high normal, mainly in working memory and verbal fluency. In this first approach, LEGO® Education method proved to be a useful tool for the neuropsychological empowerment of these patients.

Un caso de síndrome de embolia grasa: tratamiento y rehabilitación neurológica y cognitiva / A case report off at embolism syndrome: Treatment and neurological and cognitive rehabilitation

Resumen Se reporta el proceso de recuperación y rehabilitación neurológica y cognitiva de una mujer joven que desarrolló un síndrome de embolia grasa con repercusiones neurológicas, después de sufrir un politraumatismo. La paciente era una mujer de 21 años de edad con fractura cerrada de húmero y fémur izquierdos, que presentó un síndrome de embolia grasa, neumotórax izquierdo e hipertensión pulmonar, en las primeras 24 horas después de un accidente. Estuvo hospitalizada un mes y quedó con varios déficits neurológicos centrales, como infartos 'lacunares' y necrosis cortical laminar occipital, así como limitaciones en la bipedestación, la marcha, la visión y las funciones cognitivas. A partir del primer mes después del alta hospitalaria, se comenzó un proceso integral de rehabilitación neurológica y cognitiva en casa, y posteriormente, en una unidad médica de rehabilitación. Durante los primeros dos años después del accidente, la paciente recibió estimulación sensorial, sensoperceptiva y motora, así como rehabilitación motora y visual intensiva. Una vez se recuperó físicamente, se inició un proceso de rehabilitación neuropsicológica. Seis años después del accidente, la paciente terminó sus estudios universitarios y hoy está laboralmente activa. El proceso de rehabilitación neurológica es complejo, individual y difícil, aunque no imposible, y no se puede estandarizar un patrón de recuperación para todos los pacientes. Si bien existe la recuperación espontánea, la cual se da en los primeros seis meses, el caso aquí reportado demuestra que, en la fase crónica, la recuperación se puede lograr, pero requiere de evaluaciones y técnicas coordinadas de rehabilitación neurológica.

Abstract We report the neurological and cognitive recovery and rehabilitation process in a young woman who developed a fat embolism syndrome with neurological repercussions secondary to multiple trauma. The patient was a 21-year-old woman with a closed fracture of the left humerus and femur. She developed fat embolism syndrome, left pneumothorax and pulmonary hypertension in the first 24 hours after the accident. After one month of hospitalization, the patient had several central neurological deficits such as lacunar infarcts and occipital laminar cortical necrosis, as well as limitations in standing, walking, vision, and cognitive functions. An integral process of neurological and cognitive rehabilitation--first at home and later in a medical rehabilitation unit-- was carried out from the first month after being released from the hospital. During the first two years after the accident, the patient received sensory and motor stimulation, motor rehabilitation, and intensive visual rehabilitation. Once recovered physically, a process of neuropsychological rehabilitation began. Six years after the accident, the patient finished her university studies and she is working actively. The neurological rehabilitation process is complex, individual and difficult, but not impossible, and a recovery pattern cannot be standardized for all patients. Although there is spontaneous recovery, which occurs in the first six months, the case here reported shows that in the chronic phase recovery can be achieved but requires evaluations and coordinated techniques of neurological rehabilitation.

Traumatismo Encéfalo Craneano: re- construyendo aprendizajes / Traumatic brain injury: rebuilding learning

Las autoras, psicopedagogas rotantes en el Hospital de Rehabilitación Manuel Rocca, de la Ciudad de Buenos Aires, plantean distintos interrogantes alrededor de los pacientes que concurren al hospital, el tipo de abordaje que se propone, la posibles intervenciones de la especialidad en un hospital de rehabilitación, y en el proceso de rehabilitación de un adulto; y específicamente sobre el abordaje psicopedagógico de pacientes jóvenes y adultos con traumatismo encéfalo-craneano.

Perfil neuropsicológico y efectos de la rehabilitación cognitiva en la leucemia linfoblástica aguda: a propósito de un caso / Neuropsychological profile and cognitive rehabilitation training effects on acute lymphoblastic leukaemia: a case study

La Leucemia Linfoblástica Aguda (LLA) infantil es el cáncer pediátrico más frecuente. Actualmente cuenta con un alto porcentaje de supervivencia, pero dichos pacientes presentan secuelas cognitivas secundarias a la enfermedad debidas, principalmente, al tratamiento médico recibido para evitar la recidiva del cáncer. Por lo tanto, resulta necesaria la implementación de programas de rehabilitación cognitiva específicos para este tipo de población. Es por ello que el objetivo del presente estudio fue describir los déficits cognitivos en un varón de 17 años que fue diagnosticado con LLA a los 9 años. Tras la valoración neuropsicológica inicial se desarrolló un programa de rehabilitación cognitiva intensivo durante dos años consecutivos. Realizamos un estudio pre-post en el que administramos el Conners Continuous Performance Test (CPT-II) y la Escala de Inteligencia de Wechsler para niños (WISC-IV). Los resultados, antes de la intervención, mostraron que el paciente manifestaba una menor velocidad de procesamiento y dificultades de atención sostenida y alternante, comprensión verbal y razonamiento perceptivo. Además, también presentó un número considerable de errores perseverativos, signo de dificultades de flexibilidad cognitiva y control inhibitorio. Dichos déficits mejoraron notablemente tras el programa de rehabilitación cognitiva. En conclusión, nuestro estudio pone de manifiesto la necesidad de aplicar programas de rehabilitación cognitiva tempranos para paliar las secuelas cognitivas derivadas de la LLA y de su tratamiento médico, así como mejorar la calidad de vida del paciente, ya que las mejoras cognitivas redundarán en su rendimiento académico y en su funcionamiento cotidiano.

Childhood Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer. It currently has a high survival rate, but these patients have cognitive sequelae secondary to the disease, mainly due to the medical treatment received to prevent cancer recurrence. Therefore, it is necessary to implement specific cognitive rehabilitation programs for this type of population. Hence, the main objective of this study was to describe cognitive deficits in a 17-year-old male who was diagnosed with ALL when he was 9 years old. After the initial neuropsychological evaluation, an intensive cognitive rehabilitation program was developed during two consecutive years. We conducted a pre-post study in which we administered the Conners Continuous Performance Test (CPT-II) and the Wechsler Intelligence Scale for Children (WISC-IV). Results, before the intervention, showed that the patient presented a lower processing speed and difficulties of sustained and alternating attention, verbal comprehension and perceptive reasoning; in addition to a large number of perseverative errors, sign of self-monitoring difficulties and inhibitory control. These deficits improved markedly after a program of cognitive rehabilitation. In conclusion, our study highlights the need to apply early cognitive rehabilitation programs to alleviate the cognitive sequelae derived from ALL and its medical treatment. In addition, any improvement in their cognitive capabilities will have a positive impact in their academic performance and quality of life.

Dual Task Multimodal Physical Training in Alzheimer's Disease: Effect on Cognitive Functions and Muscle Strength / Treinamento Físico Multimodal com Dupla Tarefa na Doença de Alzheimer: Efeito nas Funções Cognitivas e na Força Muscular

Abstract The aim of this study was to evaluate the effects of dual task multimodal physical training (MPT) on the cognitive functions and muscle strength in older adults with AD. Participants were 19 subjects with AD in the mild and moderate stages, divided into training group (TG) and control group (CG). The TG performed dual task MPT for 12 weeks. Subjects were evaluated at the pre- and post-intervention moments. The Mini Mental State Examination (MMSE), Clock Drawing Test (CDT) and Frontal Assessment Battery (FAB) were used to assess cognition. For muscle strength, the Chair Lift and Sit Test (CLST) and Manual Grasp Force (MGF) were used. The Wilcoxon test was used to analyze pre and post intragroup moments. The TG showed a significant improvement in FAB and CLST (p≤0.05) and a tendency to improve the MMSE score (p≤0.08). The CG showed significant improvement in CLST (p≤0.05). Dual task MPT improves the frontal cognitive functions and lower limb muscle strength of older adults with AD.

Resumo Objetivou-se avaliar os efeitos do treinamento físico multimodal (TFM) com dupla tarefa nas funções cognitivas e força muscular de idosos com DA. Participaram 19 indivíduos com DA no estágio leve e moderado, divididos em grupo treinamento (GT) e grupo controle (GC). O GT realizou TFM com dupla tarefa por 12 semanas. Os idosos foram avaliados no momento pré e pós-intervenção. Para avaliação da cognição foram utilizados o Mini Exame do Estado Mental (MEEM), Teste do Desenho do Relógio (TDR) e Bateria de Avaliação Frontal (BAF). Para a força muscular o Teste de Levantar e Sentar da Cadeira (TLSC) e Força de Preensão Manual (FPM). O teste de Wilcoxon foi utilizado para analisar os momentos pré e pós-intragrupos. O GT apresentou melhora significativa na BAF e TLSC (p≤0,05) e tendência de melhora no escore do MEEM (p≤0,08). O GC apresentou melhora significativa no TLSC (p≤0,05). O TFM com dupla tarefa melhorou as funções cognitivas frontais e a força muscular de membros inferiores de idosos com DA.

Potential role of a cognitive rehabilitation program following left temporal lobe epilepsy surgery / Reabilitação neuropsicológica em pacientes com epilepsia submetidos à lobectomia temporal dominante

ABSTRACT Research into memory and epilepsy has focused on measuring problems and exploring causes with limited attention directed at the role of neuropsychological rehabilitation in alleviating post-operative memory difficulties. Objectives To assess the effects of a memory rehabilitation program in patients with left temporal lobe epilepsy following surgery. Methods Twenty-four patients agreed to participate and 18 completed the study; nine received memory rehabilitation while nine had no input and were designated as controls. Verbal learning efficiency, naming abilities, memory subjective ratings, ecological activity measures and a language fMRI paradigm were used as outcome measures. Results Improved verbal learning and naming test performance, increase in memory strategy use and improved self-perception were observed following the rehabilitation. Changes in fMRI activation patterns were seen in the rehabilitation group over the long term. Conclusion The findings support the potential role of a cognitive rehabilitation program following left temporal lobe surgery.

RESUMO As publicações na área de epilepsia e memória se focam em mensurar prejuízos e investigar causas, com poucos dados sobre reabilitação neuropsicológica em pacientes pós-cirúrgicos. Objetivos Avaliar os efeitos da reabilitação neuropsicológica em pacientes submetidos a lobectomia temporal dominante. Métodos Vinte e quatro pacientes iniciaram o estudo, apenas dezoito o concluíram, dos quais 9 foram participantes de sessões de reabilitação com enfoque em memória. Todos os participantes foram avaliados quanto a autopercepção de dificuldades de memória; ao uso de estratégias para minimizar tais dificuldades; a habilidade de nomeação e a aprendizagem verbal e foram submetidos à ressonância magnética funcional. Resultados Foi encontrado efeito significativo da reabilitação neuropsicológica na autopercepção de dificuldades de memória; no uso de estratégias compensatórias; na aprendizagem verbal e na nomeação. Alterações no padrão de ativação na RMf foram observadas no grupo submetido a reabilitação. Conclusão A reabilitação neuropsicológica pode beneficiar pacientes submetidos a lobectomia temporal antero-mesial dominante com prejuízos de memória.

Cognitive cooperation groups mediated by computers and internet present significant improvement of cognitive status in older adults with memory complaints: a controlled prospective study / Grupos de Cooperação Cognitiva mediados pelo uso de computadores e internet mostram uma melhora significativa no estado cognitivo em idosos com queixas de memória: estudo controlado prospectivo

ABSTRACT Objective To estimate the effect of participating in cognitive cooperation groups, mediated by computers and the internet, on the Mini-Mental State Examination (MMSE) percent variation of outpatients with memory complaints attending two memory clinics. Methods A prospective controlled intervention study carried out from 2006 to 2013 with 293 elders. The intervention group (n = 160) attended a cognitive cooperation group (20 sessions of 1.5 hours each). The control group (n = 133) received routine medical care. Outcome was the percent variation in the MMSE. Control variables included gender, age, marital status, schooling, hypertension, diabetes, dyslipidaemia, hypothyroidism, depression, vascular diseases, polymedication, use of benzodiazepines, exposure to tobacco, sedentary lifestyle, obesity and functional capacity. The final model was obtained by multivariate linear regression. Results The intervention group obtained an independent positive variation of 24.39% (CI 95% = 14.86/33.91) in the MMSE compared to the control group. Conclusion The results suggested that cognitive cooperation groups, mediated by computers and the internet, are associated with cognitive status improvement of older adults in memory clinics.

RESUMO Objetivo Avaliar o efeito da participação em Grupos de Cooperação Cognitiva mediados por computadores e internet na variação do Mini-Exame de Estado Mental (MEEM) de pacientes ambulatoriais com queixas de memória, participantes de duas clínicas de memória. Métodos Estudo prospectivo de intervenção controlada, realizado em 2006-2013 com 293 idosos. O grupo de intervenção (n = 160) participou de um Grupo de Cooperação Cognitiva (20 sessões de 1,5 horas cada). O grupo controle (n = 133) recebeu acompanhamento médico. O desfecho foi a variação percentual no MEEM. As variáveis de controle incluíram genêro, idade, estado civil, escolaridade, hipertensão, diabetes, dislipidemia, hipotiroidismo, depressão, doenças cardiovasculares, polimedicação, uso de benzodiazepínicos, exposição ao tabaco, sedentarismo, obesidade e capacidade funcional. Todas as variáveis foram coletadas antes e após a intervenção. O modelo multivariado final foi obtido por regressão linear múltipla. Resultados O grupo de intervenção obteve variação positiva independente de 24,39% (IC95% = 14.86/33.91) no MEEM em relação ao grupo controle. Conclusão Os resultados deste estudo sugerem que o grupo de intervenção, mediados por computadores e internet estão associados com melhora do status cognitivo em idosos de clínicas de memória.

Intervention program efficacy for spelling difficulties / Eficácia do programa de intervenção para dificuldades ortográficas

OBJECTIVE: To develop an intervention procedure for spelling difficulties and to verify the effectiveness of the intervention program in students with lower spelling performance. METHOD: We developed an intervention program for spelling difficulties, according to the semiology of the errors. The program consisted of three modules totaling 16 sessions. The study included 40 students of the third to fifth grade of public elementary education of the city of Marilia (SP), of both genders, in aged of eight to 12 years old, being distributed in the following groups: GI (20 students with lower spelling performance) and GII (20 students with higher spelling performance). In situation of pre and post-testing, all groups were submitted to the Pro-Orthography. RESULTS: The results statistically analyzed showed that, in general, all groups had average of right that has higher in post-testing, reducing the types of errors second semiologycal classification, mainly related to natural spelling errors. However, the results also showed that the groups submitted to the intervention program showed better performance on spelling tests in relation to not submitted. CONCLUSION: The intervention program developed was effective once the groups submitted showed better performance on spelling tests in relation to not submitted. Therefore, the intervention program can help professionals in the Health and Education to minimize the problems related to spelling, giving students an intervention that is effective for the development of the spelling knowledge. .

OBJETIVO: Elaborar um procedimento de intervenção para as dificuldades ortográficas e verificar a eficácia do programa de intervenção em escolares com desempenho ortográfico inferior. MÉTODO: Foi elaborado um programa de intervenção para as dificuldades ortográficas segundo a semiologia dos erros. O programa foi composto por três módulos, totalizando 16 sessões. Participaram deste estudo 40 escolares do terceiro ao quinto ano do ensino fundamental público da cidade de Marília (SP), de ambos os gêneros, na faixa de oito a 12 anos de idade, sendo distribuídos nos seguintes grupos: GI (20 escolares com desempenho ortográfico inferior) e GII (20 escolares com desempenho ortográfico superior). Em situação de pré e pós-testagem, todos os grupos foram submetidos à aplicação do Pró-Ortografia. RESULTADOS: Os resultados analisados estatisticamente evidenciaram que, de maneira geral, todos os grupos apresentaram médias de acertos que se tornaram superiores na pós-testagem, diminuindo os tipos de erros segundo a sua classificação semiológica, principalmente relacionada aos erros de ortografia natural. No entanto, os resultados também mostraram que os grupos submetidos à intervenção registraram melhor desempenho em relação aos não submetidos. CONCLUSÃO: O programa de intervenção elaborado foi eficaz uma vez que os grupos submetidos a ele apresentaram melhor desempenho nas provas ortográficas em relação aos não submetidos. Portanto, o programa de intervenção pode auxiliar profissionais da área da Saúde e da Educação a minimizar os problemas relacionados à ortografia, proporcionando aos escolares intervenção eficaz para o desenvolvimento do conhecimento ortográfico. .

Mente desorganizada y reacción catastrófica: regulación emocional intrínseca y extrínseca en sobrevivientes de lesión cerebral adquirida / Disorganized mind and catastrophic reaction: intrinsic and extrinsic emotion regulation in acquired brain injury survivors

La experiencia de tener una mente desorganiza es un fenómeno común luego de lesiones a la corteza frontal. Si bien en las últimas décadas existe un mayor conocimiento respecto a los mecanismos neuropsicológicos que colapsan en una mente desorganizada, las consecuencias emocionales de dicho problema han sido escasamente descritas. Este artículo sugiere que uno de los resultados más importantes de experimentar una mente desorganizada es la imposibilidad de utilizar dicha mente como fuente de autorregulación emocional. Además, propone que en situaciones de desorganización mental, los sobrevivientes de lesión cerebral tienden a utilizar las mentes-cerebros de otros como fuente de regulación afectiva, proceso conocido como regulación extrínseca. Por medio de la descripción de un caso clínico se intenta además demostrar como los procesos de regulación intrínseca y extrínseca se encuentran íntimamente relacionados...

The experience of a disorganized mind is a common phenomenon after pre-frontal cortex lesions. Even though during the last decades there has been a better understanding of the neuropsychological mechanisms that are often compromised in a disorganized mind, its emotional consequences have been scarcely described. This article suggests that a main problem of having a disorganized mind is the difficulty of using that same mind to self-regulate emotional states. In addition, this paper also proposes that in situations where the mind is in a state of disorganization, patients tend to use other’s people’s minds-brains as a source of affective regulation, a process commonly known as extrinsic regulation. Finally, the relationship between intrinsic and extrinsic regulatory processes is addressed through the description of a clinical case...

Virtual reality in physical rehabilitation of patients with Parkinson's disease

INTRODUCTION: The Virtual Reality (VR) can be a therapeutic tool used in neurorehabilitation field. It is considered a ludic activity that provides visual and auditory feedbacks, facilitating the patients' adherence to treatment. AIMS: To perform literature review about influences of VR in rehabilitation of patients with Parkinson's disease. METHODS: Data banks were used from the following virtual libraries: Medline, PEDro, Lilacs, Scielo and PubMed using the following keywords: Parkinson's disease and Virtual Reality; Parkinson's disease and Wii as well as analogous keywords in Spanish and Portuguese to obtain the scientific papers. PEDro scale was used to analyze the methodological quality of the papers. RESULTS: From fifty papers obtained after inclusion and exclusion criteria were retained 16 papers to analyses. According to PEDro scale most of the papers had low score. The results suggest that VR shows positive aspects in velocity and movement time, balance, gait, postural control and functionality of upper extremities. The ludic activity provided by VR and the contribution of visual and auditory feedbacks of this intervention can be the great potential of this new tool. CONCLUSION: The VR is useful to make potent: motor control, functionality, cognitive capacity and balance, but still need more scientific studies with methodological qualities to confirm the results of the VR in Parkinson's disease...

INTRODUÇÃO: A realidade virtual (RV) pode ser uma ferramenta terapêutica utilizada no campo da neurorreabilitação. É considerada uma atividade lúdica que fornece feedback visual e auditivo, facilitando a adesão dos pacientes ao tratamento. OBJETIVO: Realizar uma revisão de literatura a respeito da influência da RV na reabilitação de pacientes com doença de Parkinson. Método: Utilizamos como base de dados os sistemas virtuais das bibliotecas Medline, PEDro, Lilacs, Scielo e Pubmed, a partir dos seguintes descritores: Doença de Parkinson e Realidade Virtual; Doença de Parkinson e Wii e seus equivalentes em espanhol e inglês para obtenção dos artigos. Foi utilizada a escala PEDro para fins de pontuação metodológica dos artigos analisados. RESULTADOS: A partir de 50 artigos obtidos após a aplicação dos critérios de inclusão e exclusão, foram obtidos 16 artigos para análise. De acordo com a escala PEDro a maioria dos artigos teve baixa pontuação. Os resultados sugerem que a RV apresenta resultados positivos nas variáveis velocidade e tempo de movimento, equilíbrio, marcha, controle postural e funcionalidade de membros superiores. A atividade lúdica oferecida pela RV e a contribuição dos feedbacks visual e auditivo oferecido por este tipo de intervenção podem ser o grande potencial desta nova ferramenta. CONCLUSÃO: A RV é útil na potencialização do controle motor, na funcionalidade, na capacidade cognitiva e no equilíbrio, mas ainda precisa de estudos com melhor qualidade metodológica para confirmação dos resultados da RV na doença de Parkinson...

Improvement of motor function and decreased need for postnatal shunting in children who had undergone intrauterine myelomeningocele repair / Melhora em função motora e necessidade reduzida de shunts pós-natais em crianças submetidas a cirurgia fetal uterina da mielomeningocele

Objective To compare neuromotor development between patients who did and those who did not undergo intrauterine myelomeningocele repair. Methods Children with myelomeningocele aged between 3.5 and 6 years who did undergo intrauterine repair (Group A, n=6) or not (Group B; n=7) were assessed for neuromotor development at both anatomical and functional levels, need for orthoses, and cognitive function. Results Intrauterine myelomeningocele repair significantly improved motor function. The functional level was higher than the anatomical level by 2 or more spinal segments in all children in Group A and 2 children in Group B, with a significant statistical difference between groups (p<0.05). Five children in Group A and one in Group B were community ambulators. Conclusion Despite the small sample, it was observed that an improvement of motor function and decreased need for postnatal shunting in the 6 children who had undergone intrauterine myelomeningocele repair. .

Objetivo Comparar o desenvolvimento neuromotor de pacientes submetidos à cirurgia fetal intrauterina da mielomeningocele ao de pacientes não submetidos ao procedimento. Métodos Foram avaliados: o desenvolvimento neuromotor (descrevendo o nível anatômico e motor funcional), o tipo de marcha, a necessidade de órteses e o nível cognitivo de crianças com mielomeningocele entre 3,5 e 6 anos de idade, submetidas (Grupo A; n=6) ou não submetidas (Grupo B; n=7) à cirurgia fetal intra-uterina. Resultados A função motora apre-sentou melhora significante, com nível funcional mais elevado em dois ou mais segmentos em relação ao nível anatômico em todas as crianças do Grupo A e em duas crianças do Grupo B, com diferença estatística entre os grupos (p<0.05). Cinco crianças do Grupo A e uma do grupo B eram deambuladoras comunitárias. Conclusão Apesar da pequena amostragem, nos 6 casos de cirurgia prenatal observouse melhora da função motora e menor necessidade de shunts pós-natais. .

Búsqueda e inclusión laboral de personas con discapacidad cognitiva en Chile: una mirada desde sus madres / Job search and inclusion of people with cognitive disability in Chile: a look from their mothers

El presente artículo identifica los factores sociales que inciden en el proceso de búsqueda e inclusión laboral de jóvenes que presentan una discapacidad cognitiva en Chile, intentando dilucidar qué aspectos se constituyen en barreras para la incorporación a un trabajo desde la perspectiva de sus madres. Se basa en una investigación cualitativa en la que se utilizaron entrevistas en profundidad y cuestionarios semi estructurados, para identificar las visiones y significaciones de las madres de jóvenes con discapacidad cognitiva en torno al proceso de búsqueda e incorporación laboral. Como principales resultados, se han identificado tres tipos de obstáculos al empleo de los jóvenes con discapacidad cognitiva en el discurso de las entrevistadas: obstáculos sociales, personales y doméstico familiares. En el plano social, las participantes señalan la falta de interés por parte de empresas privadas, la prevalencia de estereotipos y la creencia común que las personas con discapacidad son menos productivas. En el plano interno/nivel de familia, los padres se reconocen temerosos ante el proceso de integración, lo que asocian a que las personas con discapacidad cognitiva son más vulnerables y se encuentran expuestas a sufrir abusos o perjuicios, por lo que toman una postura selectiva ante las posibles ofertas de empleo. En lo que respecta al nivel personal, encontramos las declaraciones asociadas a una baja autoestima, inseguridad, falta de autonomía comunicativa y problemas de salud de las personas con discapacidad cognitiva, que influyen en la capacidad de búsqueda y en la adecuación personal al puesto de trabajo.

The aim of this paper is to stress out the the social factors that Chilean young people with cognitive disability have to face in the process being inserted in a job. It intents to figure out, from the mothers’ point of view, the aspects that constitutes a barrier for their children to be employed. This survey has been conducted from a multidisciplinary setting and a qualitative design, using interviews and a semi structured survey. As main outcomes, we have indentified three kinds of barriers: social, personal and domestic/family. At a social level, mothers point out the lack of interest from private corporations, the prevalence of stereotypes and the common belief that disabled people areless productive. At the domestic/family level, most parents are reluctant to agree with the labor integration process, mainly because they think that their children might be abused or deceived by the employers and their teamwork. Therefore, they are extremely cautious when selecting job opportunities. As a personal level, mothers found statements associated to low self-esteem, unsteadiness, lack of autonomy and communicative disabilities.

Reabilitação cognitiva em idosos institucionalizados: um estudo piloto / Cognitive rehabilitation on elderly institutionalized people: a pilot study

Este estudo descreve os efeitos da intervenção de terapia ocupacional no desempenho cognitivo, e analisa a influência deste desempenho na capacidade funcional de idosos institucionalizados. Trata-se de um estudo clínico randomizado, descritivo, longitudinal, realizado em uma instituição pública de longa permanência de idosos. Os 12 idosos que participaram do estudo foram divididos em dois grupos: experimental e controle. Para obtenção dos dados, foram utilizados: um questionário com dados sociodemográficos; o Mini-Exame do Estado Mental, o Teste de Fluência Verbal e o Teste do Relógio, para avaliação do desempenho cognitivo; e a Escala de Katz da Atividade de Vida Diária e o Questionário de Atividades Funcionais de Pfeffer, para avaliação da capacidade funcional. Os idosos do grupo experimental foram submetidos a uma intervenção com 23 sessões de reabilitação cognitiva. O grupo que recebeu a intervenção apresentou resultados estatisticamente significativos no desempenho cognitivo, mas não houve resultados estatisticamente significativos no desempenho da capacidade funcional quando comparados com o grupo controle. Conclui-se que a intervenção de terapia ocupacional teve efeitos significativos no desempenho cognitivo de idosos institucionalizados e que, provavelmente, o desempenho na capacidade funcional não foi tão significativo, por se tratar de idosos que, em sua maioria, apresentam limitação motora e dependência instalada.

ABSTRACT: This study describes the effects of occupational therapy on cognitive performance and its influence on the functional capabilities of older institutionalized persons. The research design was random, descriptive and longitudinal, and conducted in a long term public institution for the elderly. The data were based on results from the following measures: For cognitive abilities, a Socio-Demographic Questionnaire, the Mental State Mini-Exam, a Verbal Fluency Test, and the Clock Test. For functional capacity, the Katz Scale of Daily Living Activity and the Pfeffer Questionnaire of Functional Activities was used. Old people in the experimental group underwent 23 cognitive training sessions. The mean level of cognitive performance of the experimental group differed significantly from that of the control group; however, there was no significant between-group difference for emotional capacity. In conclusion, the use of occupational therapy exerted significant effects on the cognitive performance of institutionalized older persons, and although the therapy produced some positive outcomes in functional capacity, the inter-group difference did not reach statistical significance.

Programa de remediação fonológica em escolares com dificuldades de aprendizagem / Phonological remediation program in students with learning difficulties

OBJETIVO: Verificar a eficácia do programa de remediação fonológica em escolares com dificuldades de aprendizagem. MÉTODOS: Participaram 40 escolares, de 2ª a 4ª séries do município de Marília (SP), de ambos os gêneros, faixa etária de oito anos e um mês a 12 anos, que foram distribuídos em dois grupos: Grupo 1 (G1), composto por 20 escolares com dificuldades de aprendizagem; e Grupo 2 (G2), composto por 20 escolares sem dificuldades de aprendizagem. Foram aplicados o Teste de Desempenho Cognitivo-Linguístico e a prova de leitura oral e compreensão de textos em todos os escolares, pré e pós testagem. Os participantes do Grupo 1 foram submetidos ao programa de remediação fonológica após a pré-testagem. RESULTADOS: Ao final do programa de remediação fonológica o Grupo 1 apresentou diferença para as habilidades de leitura, processamento auditivo, visual e velocidade de processamento, evidenciada por desempenho superior na pós-testagem. CONCLUSÃO: Houve eficácia do programa de remediação fonológica para o desenvolvimento de habilidades cognitivo-linguísticas e de leitura e compreensão de texto para escolares com dificuldade de aprendizagem.

PURPOSE: To verify the effectiveness of a phonological remediation program in students with learning difficulties. METHODS: Forty students from 2nd to 4th grades, from both genders, ranging from eight years and one month to 12 years old, were divided into two groups: Group 1 (G1), composed by 20 students with learning disabilities; and Group 2 (G2), composed by 20 students without learning disabilities. The Cognitive-Linguistic Performance Test and the oral reading and comprehension were applied in pre-test and post-test situations in all students. After the pre-test, only the students from Group 1 were submitted to the phonological remediation program. RESULTS: After the phonological remediation program, Group 1 presented differences for reading abilities, auditory and visual processing, and processing speed, evidenced by superior performance in the post-testing situation. CONCLUSION: The phonological remediation program was efficient to the development of cognitive-linguistic skills and reading and text comprehension of students with learning difficulties.

Effects of a multidisciplinar cognitive rehabilitation program for patients with mild Alzheimer's disease

OBJECTIVE: To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatry symptoms in patients with mild Alzheimer's disease. METHOD: The present study was a single-blind, controlled study that was conducted at a university-based day-hospital memory facility. The study included 25 Alzheimer's patients and their caregivers and involved a 12-week stimulation and psychoeducational program. The comparison group consisted of 16 Alzheimer's patients in waiting lists for future intervention. INTERVENTION: Group sessions were provided by a multiprofessional team and included memory training, computer-assisted cognitive stimulation, expressive activities (painting, verbal expression, writing), physiotherapy, and physical training. Treatment was administered twice a week during 6.5-h gatherings. MEASUREMENTS: The assessment battery comprised the following tests: Mini-Mental State Examination, Short Cognitive Test, Quality of Life in Alzheimer's disease, Neuropsychiatric Inventory, and Geriatric Depression Scale. Test scores were evaluated at baseline and the end of the study by raters who were blinded to the group assignments. RESULTS: Measurements of global cognitive function and performance on attention tasks indicated that patients in the experimental group remained stable, whereas controls displayed mild but significant worsening. The intervention was associated with reduced depression symptoms for patients and caregivers and decreased neuropsychiatric symptoms in Alzheimer's subjects. The treatment was also beneficial for the patients' quality of life. CONCLUSION: This multimodal rehabilitation program was associated with cognitive stability and significant improvements in the quality of life for Alzheimer's patients. We also observed a significant decrease in depressive symptoms and caregiver burden. These results support the notion that structured nonpharmacological interventions can yield adjunct and clinically relevant benefits in dementia treatment.

Comprometimento cognitivo leve e reabilitação neuropsicológica: uma revisão bibliográfica / Mild cogntive impairment and neuropsychological rehabilitation: a systematic review

O Comprometimento Cognitivo Leve (CCL) é frequentemente definido como a zona de transição entre o envelhecimento saudável e a demência, sendo comuns déficits de memória. Assim, a Reabilitação Neuropsicológica (RN) pode ser uma importante intervenção, envolvendo aspectos cognitivos, comportamentais e emocionais, buscando a melhora da qualidade de vida do idoso. A presente revisão bibliográfica investigou os benefícios da RN para os idosos com CCL. Por meio das bases de dados MEDLINE e PsycINFO foram encontrados 15 estudos, publicados entre 2002 e maio de 2009. Como resultado das intervenções realizadas foi descrita melhora das funções cognitivas, tais como memória episódica e operacional, praxia construtiva, aprendizado psicomotor, raciocínio e velocidade de processamento. Além disto, houve benefícios funcionais e emocionais, tais como melhora do bem estar, da autoconfiança, da percepção sobre a própria memória, nos relacionamentos sociais e no humor. Todavia, houve controvérsias entre os estudos e limitações metodológicas importantes, sendo necessárias pesquisas com amostras maiores, desenhos experimentais controlados e randomizados, maior consenso sobre os intrumentos utilizados e mais acompanhamento a longo prazo dos benefícios alcançados.

Mild Cognitive Impairment (MCI) is often conceptualized as a transitional stage between healthy aging and dementia, and is usually associated with memory lapses. Neuropsychological Rehabilitation (NR) – dealing with cognitive, behavioral and emotional aspects - can be a useful intervention, capable of improving quality of life. This systematic review aimed to investigate the benefits of NR to elderly people with MCI. The literature was searched using key terms in the MEDLINE and PsycINFO databases and 15 studies were identified, all of them published from 2002 until May 2009. Cognitive benefits were described, such as episodic and working memory, constructive praxis, psychomotor learning, reasoning and processing speed. Furthermore, there were functional and emotional gains, such as improved well-being, self-confidence, perception of their own memory, social relations and mood. However, there were some controversial issues between studies and methodological limitations. Thus, large samples and robust experimental design (controlled and randomized studies) are needed, as well as higher consensus about the cognitive and functional measures and longer term follow-up.

Efectos de un programa de estimulación cognitiva en la memoria operativa en pacientes con deterioro cognitivo leve amnésico / Effects of a cognitive stimulation program in working memory in patients with amnestic mild cognitive impairment

Introducción: El deterioro cognitivo leve (DCL) es una condición intermedia entre el envejecimiento normal y la demencia. Este estudio propone la aplicación de un programa de estimulación cognitiva multifactorial (PECM), para establecer la naturaleza de los cambios que se pudieran inducir en la memoria operativa (MO) de un grupo de mujeres mayores con DCL de tipo amnésico (DCL-A). Pacientes y Métodos: Se seleccionó a conveniencia una muestra de 7 mujeres con diagnóstico de DCL-A, a quienes se les hizo mediciones neuropsicológicas y de MO antes y después de 24 sesiones de un PECM, de una hora cada una, con una frecuencia de tres veces por semana. Para medir la MO se uso la batería para la evaluación de la memoria operativa de Pickering, Baqués y Gathercole. Resultados: Se hallaron diferencias estadísticamente significativas (p<0.05) y clínicamente importantes (TE>0.75), en componentes de la MO, especialmente de la agenda visoespacial (AV) y del ejecutivo central (EC). Conclusiones: Un PECM mejora los componentes de la AV y del EC de la MO en mujeres con DCL-A. Hay una tendencia similar en el bucle fonológico, pero el tamaño pequeño de la muestra no pudo descartar la hipótesis nula.

Introduction: Mild cognitive impairment (MCI) is considered as an intermediate status between normal aging and dementia. This study proposes the administration of a program of cognitive multifactor stimulation (PCMS), toestablish the changes on Working Memory (WM) in an elderly female group with amnesic type MCI (A-MCI). Patients and Methods: A sample of seven females over sixty years old with A-MCI, which were assessed for neuropsychological function and WM, before and after a 24 sessions of one hour PCMS, three times per week. To measure WM was used the Pickering, Baqués and Gathercole’ s battery. Results: Statistically significant differences (p < 0,05) and clinically important findings (effect sizes > 0,75) on WM components, specially on visual loop (VL) and central executive (CE). Conclusion: A PCMS improved the VL and CE components of WM in seven elderly females with AMCI. The phonologic loop had a similar tendency, but the small sample size did not allow rejecting the null hypothesis.

Comparative Efficacy of Cognitive Retraining Techniques and Remedial Training in Children with Learning Disability.

Background : Computer-assisted cognitive retraining approaches that work on the principle of cerebral plasticity are by now established rehabilitation methods for various neuropsychiatric conditions including Learning Disability. Also, remedial education is considered to be an integral part of management of learning disability. Objectives: To compare the efficacy of cognitive retraining techniques and remedial education for enhancing academic performance of children with learning disability. Sample & Methods: Pre-Post experimental design study was carried out with forty children(between seven to ten years of age), with diagnosis of mixed disorder of scholastic skills (ICD-10). Subjects in Group1 (n=20) were given 36 hours of manualized CR package over 18weeks, consisting of activities for sustained attention, visuospatial skills, visual memory; and verbal learning and memory. Subjects in group 2 (n=20) were given 36-remedial education sessions. Pre and post intervention assessment; was done using NIMHANS Index for Specific Learning Disability, Grade Level Assessment Device(GLAD).SPSS version 12.0 was used for descriptive and analytical statistical analysis. Results: Highly significant improvement was noted in mathematics (p > 0.01) for Group 1. Also, there was significant improvement in Hindi language of Group 2 (p > 0.05). Conclusion: Both-manualized cognitive retraining and remedial education over thirty six hours can help to partially improve scholastic performance in children with learning disability. The findings have implications for combining both the approaches for future educational curricula aiming at improved academic performance stemming from an enhanced skill base rather than from just educational based interventions.