[The 'awareness climbing': an educational board game for improving self-awareness following acquired brain injury]. / 'Escalada de la conciencia': un instrumento para mejorar la conciencia de enfermedad en pacientes con dano cerebral adquirido.

AIM: To establish the effectiveness of an educational board game for improving self-awareness following acquired brain injury. PATIENTS AND METHODS: The 'awareness climbing' is a board game format intervention for improving awareness of patients with acquired brain injury (ABI) and for facilitating the use of anticipatory and compensatory strategies. 17 patients with ABI (traumatic brain injury, 10; stroke, 5; others, 2) were included in a self-awareness rehabilitation program using the 'awareness climbing'. Self-awareness was assessed with the Self-Awareness of Deficit Interview (SADI) before and after game intervention. According to the SADI self-awareness consists of three-interdependent levels: intellectual awareness (impairments), emergent awareness (disability) and anticipatory awareness, which involve the client predicting when impairments will affect his or her performance. RESULTS: Initially five patients showed impaired intellectual awareness, four patients had difficulties on emergent awareness and nine patients showed deficits on anticipatory awareness. Intellectual awareness improved in 10 patients, while six patients experienced improvements in emergent awareness over the intervention period. The most striking change was an improvement in 70% of the sample (n = 11) in anticipatory awareness after game sessions. CONCLUSION: According to SADI scores we suggest that the 'awareness climbing' may be a useful tool for improving self-awareness after acquired brain injury.

‘Escalada de la conciencia’: un instrumento para mejorar la conciencia de enfermedad en pacientes con daño cerebral adquirido / The "awareness climbing". an educational board game for improving self-awareness following acquired brain injury

Objetivo. Determinar la eficacia de una herramienta lúdico-terapéutica (‘escalada de la conciencia’) como método para rehabilitar la conciencia de enfermedad en sujetos con daño cerebral adquirido (DCA). Pacientes y métodos. La ‘escalada de la conciencia’ es una herramienta lúdica que facilita la adquisición de conocimientos necesarios para la adecuada percepción de las deficiencias y pone en práctica estrategias de afrontamiento y compensación de las diferentes limitaciones funcionales generadas tras un DCA. Se incluyó a 17 pacientes con DCA (traumatismo craneoencefálico, 10; ictus, 5; otros, 2). El grado de conciencia de los déficit y de sus implicaciones funcionales se valoró mediante la Self-Awareness of Deficit Interview (SADI) antes y después de un programa de intervención que incluía esta herramienta. La entrevista SADI mide tres aspectos de la conciencia: autoconciencia de los déficit, conciencia de las consecuencias funcionales y capacidad de establecer metas realistas. Resultados. Inicialmente, cinco pacientes presentaban problemas de autopercepción de sus déficit; cuatro, problemas de autopercepción de su discapacidad, y nueve tenían dificultades para establecer metas realistas de futuro. A lo largo del proceso de seguimiento, la percepción de los déficit mejoró en diez pacientes, y la percepción de las dificultades generadas por tales déficit, en seis. El cambio más significativo fue que, tras las sesiones de entrenamiento, el 70% de los sujetos (n = 11) aprendió a establecer metas realistas en función de los problemas generados por su patología. Conclusión. Los resultados obtenidos en la entrevista SADI convierten la ‘escalada de la conciencia’ en un instrumento válido y útil en el proceso rehabilitador de la conciencia de enfermedad en pacientes con DCA

Aim. To establish the effectiveness of an educational board game for improving self-awareness following acquired brain injury. Patients and methods. The ‘awareness climbing’ is a board game format intervention for improving awareness of patients with acquired brain injury (ABI) and for facilitating the use of anticipatory and compensatory strategies. 17 patients with ABI (traumatic brain injury, 10; stroke, 5; others, 2) were included in a self-awareness rehabilitation program using the ‘awareness climbing’. Self-awareness was assessed with the Self-Awareness of Deficit Interview (SADI) before and after game intervention. According to the SADI self-awareness consists of three-interdependent levels: intellectual awareness (impairments), emergent awareness (disability) and anticipatory awareness, which involve the client predicting when impairments will affect his or her performance. Results. Initially five patients showed impaired intellectual awareness, four patients had difficulties on emergent awareness and nine patients showed deficits on anticipatory awareness. Intellectual awareness improved in 10 patients, while six patients experienced improvements in emergent awareness over the intervention period. The most striking change was an improvement in 70% of the sample (n = 11) in anticipatory awareness after game sessions. Conclusion. According to SADI scores we suggest that the ‘awareness climbing’ may be a useful tool for improving self-awareness after acquired brain injury

[Anoxic encephalopathy after ultraviolet radiation session: follow-up and results]. / Encefalopatía hipoxico-isquémica tras sesión de rayos ultravioleta: evolución y seguimiento.

Anoxic encephalopathy is the consequence of acute cerebral oxygen deprivation usually generated by cardiac arrest and/or respiratory failure. Recently an interesting case of one patient with cerebral anoxia after ultraviolet radiation session has been published. This paper shows the clinical evolution of this patient after inclusion in a multidisciplinary rehabilitation program, which included treatment of the psychopathological, neuropsychological and functional impairments that this pathology often generates. Over successive decades cerebral anoxia has come to be identified principally as one of the most significant causes of an isolated amnesia syndrome. Our patient presented at baseline intense difficulties in every verbal and visual memory processes associated with moderate impairments in sustained, selective and shifting attention as well as temporal disorientation. Compensation of memory deficit was the main rehabilitation strategy used in this case. This rehabilitation approach was possible thanks to the high degree of self-awareness of memory deficits shown by the patient and the selective impairment of memory with partial preservation of the rest of cognitive functions. This particular case gives us the opportunity to show the multidisciplinary approach of cognitive rehabilitation and the process of reintegration to social activities and to productive work even when deficits persist.