Evaluación y rehabilitación cognoscitiva en cáncer pediátrico: un estudio de caso / Evaluation and cognitive rehabilitation in pediatric cancer: A case report

Los niños sobrevivientes a cáncer cuya enfermedad y tratamiento involucra al Sistema Nervioso Central, presentan un patrón consistente de deficiencias neurocognoscitivas. En este artículo se describe el estudio de caso de un niño de 9 años diagnosticado con tumor de la fosa posterior sometido a cirugía, quimioterapia y radioterapia. Se aplicó la Batería Neuropsicológica Infantil en 3 momentos: posterior a la cirugía; finalizada la quimioterapia y la radioterapia y después del programa de rehabilitación cognoscitiva. Las evaluaciones neuropsicológicas después de la cirugía, quimio y radioterapia muestran deficiencias en las tareas de Habilidades Gráficas, Atención Visual y Auditiva, Porcentaje de Respuestas Correctas, Diseños Correctos con el Mínimo de Movimientos, Velocidad en la Lectura y la Escritura, Habilidades Gráficas, Codificación Visual, Memoria Verbal y Visual, Percepción Táctil, Repetición y Comprensión del Lenguaje, Habilidades Conceptuales, Fluidez Verbal y Gráfica, Precisión de la Lectura, Composición Narrativa, Conteo, Manejo Numérico y Cálculo. Después de la rehabilitación cognoscitiva observamos un incremento en el puntaje en las tareas de: Habilidades Gráficas, Memoria Verbal, Expresión y Comprensión del lenguaje, Atención Visual y Auditiva, Habilidades Conceptuales, Fluidez Verbal y Gráfica, Conteo, Manejo Numérico, Cálculo y Razonamiento Lógico Matemático. Con la implementación de las medidas normativas de la Evaluación Neuropsicológica Infantil pudimos contrastar el desempeño de nuestro paciente; el cual refleja que el programa de rehabilitación cognoscitiva potencialmente posee la eficacia suficiente para contrarrestar algunas de las secuelas neurocognoscitivas observadas después de la resección del tumor y de la radioterapia y la quimioterapia

Cancer surviving children, whose disease and treatment involves the central nervous system, show a consistent pattern of neurocognitive deficits. We report a case diagnose of a 9 years boy with posterior fossa tumor treated with surgery, chemotherapy and radiotherapy. Neuropsychological evaluation post oncological therapies and post Cognitive Remediation Program (CRP) were made to document the effect of neuropsychological rehabilitation. The results of the post oncological therapies evaluation shows deficits in Constructional Skills, Visual and Auditory Attention, Percentage of Correct Answers and Correct Designs with Minimal Movements, Speed in Reading and Writing, Graphic Skills, Visual Coding, Verbal and Visual Memory, Perception Touch, Repetition and Comprehension of Language, Conceptual Skills, Verbal and Graphics Fluency, Reading Accuracy, Narrative Composition, Count, Numerical and Calculation Management. After CRP our results illustrate an increase in the score of: Graphic Skills, Verbal Memory, Speech and Language Understanding, Conceptual Skills, Verbal and Graphics Fluency, Count, Numerical Management, Calculation and Logical Mathematical Reasoning after CRP. With the implementation of standardized measures of Evaluación Neuropsicológica Infantil we could compare the performance of our patient; which suggests that the CRP has enough potential to counteract some of the neurocognitive sequelae observed after tumor resection and radio and chemotherapy

EEG power spectral measurements comparing normal and "thatcherized" faces.

In this paper we have made a broadband analysis to detect the electroencephalogram (EEG) frequencies that change selectively during the presentation of normal and "thatcherized" faces. Referential recordings to linked ears were obtained in 21 leads in 48 right-handed healthy male volunteers. Increase of delta power (1.75-3.91 Hz) was observed, related to the detection of distortion in faces at bifrontal and left temporoparietal cortex. The other bands had no contribution, when normal and modified faces were compared. These results support our hypothesis that a change in EEG power spectral may be related to discrimination between normal and thatcherized faces.

Poor reading skills may involve a failure to focus attention.

A source localization analysis was carried out to provide brain functional and structural assessments of individuals with poor reading skills. Standardized low-resolution brain electromagnetic tomography was used to locate sources of P2 and P3 event-related potential components in normal readers and in poor reader children performing a cued continuous performance task. Cue-elicited P2 sources in the right superior parietal gyrus were smaller in 37 poor readers than in 40 normal readers. Poor readers showed a higher P3 activation in response to a false target in frontal and frontorbital regions than normal readers. These results suggest that reading disabilities may be attributed to failures in attentional focalization for incoming stimuli.

Event-related potentials findings differ between children and adults during arithmetic-fact retrieval.

Some cognitive abilities of arithmetical calculation depend on retrieval of arithmetic facts from long-term memory. Arithmetic-fact retrieval has been studied in adults through Event-Related Potentials (ERP) experiments. Such information in children, however, has been scarce. It has been reported that from the age of 9 years, children employ a memory retrieval strategy for solving simple multiplication problems. The present study compared arithmetical-fact retrieval in children and adults while they were being subjected to ERP recording. The subjects were asked to make judgments about solutions to simple multiplication problems. Both groups of participants displayed the so-called arithmetic N400 effect for incorrect solutions relative to correct solutions. Adults showed a posterior N400 effect, while children showed a widely distributed N400 effect. Children displayed a larger amplitude and longer latency arithmetic N400 component than adults; this observation could be due to children exerting greater effort involving more widespread cortical activation than adults to solve the experimental problems. The Late Positive Component (LPC), which follows the arithmetic N400 and has been described previously in adult subjects, was observed in the present adult subjects, but was present in children only for correct solutions. These results may indicate that, relative to adults, children showed slower memory retrieval and a different pattern of a verification mechanism for correct and incorrect solutions.

Narrow-band spectral measurements of EEG during emotional tasks.

The objective of this study was to discover how narrow-band spectral measurements express emotional behavior. Electroencephalographic narrowband absolute and relative spectral powers were calculated for every 1 Hz of frequency from the recordings of 40 healthy male university students during emotional tasks. Sentences evoking positive, negative, and neutral emotional states were used as stimuli. Repeated multivariate analyses of variance were computed with IQ as covariate. The results showed only a few significant relations between absolute power and emotion. Relative power reflected better the differences determined by emotional states. The frequencies between 7.6 and 9.5 Hz showed differences between emotional states over the entire scalp with increased power during neutral state. Interaction between emotional states and cerebral regions revealed that all cerebral areas had an important role, especially frontal, parietal, and temporal regions. Hemispheric differences showed less power in the left hemisphere during positive emotional state (joy of love) in the 8.6 to 9.5 Hz band and in the right hemisphere during negative emotional state (frustration) in the 17.6 to 18.5 Hz band. Significant interaction between states, hemispheres, and electrode positions was observed in the frequency range of 17.6 to 19.5 Hz. As none of our results covered the range of any broad band, we may conclude that narrow-band calculations are more adequate for the study of emotions, because their use reduces the danger that frequency-specific effects go undetected or cancel each other.