La rehabilitación neuropsicológica en el siglo XX / Neuropsychological rehabilitation in the 20th century

Introducción: Los primeros documentos que describen técnicas y procedimientos para mejorar el funcionamiento cognitivo de las personas con lesiones cerebrales datan del siglo XVII. Sin embargo, los gobiernos apenas muestran interés y destinan escasos recursos económicos, personales y materiales, posiblemente por la elevada tasa de mortalidad asociada a las lesiones cerebrales y la limitada esperanza de vida de quienes sobreviven. No es hasta el siglo XX cuando la rehabilitación neuropsicológica, como se concibe actualmente, da sus primeros pasos. Desarrollo: La evolución de la rehabilitación neuropsicológica en el transcurso del pasado siglo puede estructurarse en tres períodos: período constitutivo, período de expansión y período de consolidación. Los dos primeros se relacionan estrechamente con las intervenciones desarrolladas en tiempos de guerra (Primera y Segunda Guerra Mundial, principalmente), y el período de consolidación, con la transferencia de los avances logrados en el ámbito militar a la población civil y la irrupción de las tecnologías digitales en rehabilitación cognitiva. Conclusiones: La historia de la rehabilitación neuropsicológica del siglo XX muestra dos grandes cambios conceptuales, ligados a profundos cambios en las políticas asistenciales desplegadas por diversos gobiernos occidentales. El primero tiene lugar durante la Primera Guerra Mundial, cuando, en respuesta al creciente número de veteranos con lesiones cerebrales, los gobiernos optan por crear centros de neurorrehabilitación. Y el segundo, en las décadas de los años sesenta y setenta, cuando distintos gobiernos transfieren y generalizan a la población civil los avances logrados en la esfera militar

Introduction: The first documents describing techniques and procedures to improve the cognitive functioning of people with brain injuries date back to the 17th century. Yet, governments show little interest in it and allocate scarce economic, personal and material resources, possibly because of the high mortality rate associated with brain injuries and the limited life expectancy of those who survive. It was not until the 20th century that neuropsychological rehabilitation, as it is conceived today, took its first steps. Development: The evolution of neuropsychological rehabilitation over the last century can be structured in three periods: establishment, expansion and consolidation. The first two are closely related to the procedures developed in times of war (mainly the First and Second World Wars), and the period of consolidation is linked with the transfer of the advances made in the military field to the civilian population and the advent of digital technologies in cognitive rehabilitation. Conclusions: The history of neuropsychological rehabilitation in the 20th century shows two major conceptual changes, linked to profound modifications in the welfare policies deployed by various Western governments. The first took place during the First World War, when, in response to the growing number of veterans with brain injuries, governments decided to set up neurorehabilitation centres. And the second occurred in the 60s and 70s, when different governments transferred and generalised the advances achieved in the military sphere to the civilian population

A historical review of investigations on laterality of emotions in the human brain.

Different models of emotional lateralization, advanced since the first clinical observations raised this issue, will be reviewed following their historical progression. The clinical investigations that have suggested a general dominance of the right hemisphere for all kinds of emotions and the experimental studies that have proposed a different hemispheric specialization for positive vs. negative emotions (valence hypothesis) or for approach vs. withdrawal tendencies (motivational hypothesis) will be reviewed first and extensively. This historical review will be followed by a short discussion of recent anatomo-clinical and activation studies that have investigated (a) emotional and behavioral disorders of patients with asymmetrical forms of fronto-temporal degeneration and (b) laterality effects in specific brain structures (amygdala, ventro-medial prefrontal cortex, and anterior insula) playing a critical role in different components of emotions. Overall, these studies support the hypothesis of a right hemisphere dominance for all components of the emotional system.

Traumatic glioblastoma: commentary and suggested mechanism.

The role of head trauma in the development of glioblastoma is highly controversial and has been minimized since first put forward. This is not unexpected because skull injuries are overwhelmingly more common than glioblastoma. This paper presents a commentary based on the contributions of James Ewing, who established a major set of criteria for the recognition of an official relationship between trauma and cancer. Ewing's criteria were very stringent. The scholars who succeeded Ewing have facilitated the characterization of traumatic brain injuries since the introduction of computed tomography and magnetic resonance imaging. Discussions of the various criteria that have since developed are now being conducted, and those of an unnecessarily limiting nature are being highlighted. Three transcription factors associated with traumatic brain injury have been identified: p53, hypoxia-inducible factor-1α, and c-MYC. A role for these three transcription factors in the relationship between traumatic brain injury and glioblastoma is suggested; this role may support a cause-and-effect link with the subsequent development of glioblastoma.

Penfield's ceiling: Seeing brain injury through Galen's eyes.

The cathedral ceiling located in the entrance hall of the Montreal Neurological Institute, planned by its founder Wilder Penfield, has intrigued visitors since it was erected in 1934. Central to its charm is a cryptic comment by the ancient physician Galen of Pergamum, which refutes a dire Hippocratic aphorism about prognosis in brain injury. Galen's optimism, shared by Penfield, is curious from a fellow ancient. In this article, we use primary sources in Ancient Greek as well as secondary sources to not only examine the origins of Galen's epistemology but also, using a methodology in classics scholarship known as reception studies, illustrate how an awareness of this ancient debate can illuminate contemporary clinical contexts. While Galen based his prognostications on direct clinical observations like the Hippocratics, he also engaged in experimental and anatomic work in both animals and humans, which informed his views on neurologic states and outcomes. Penfield's memorialization of Galen is representative of the evolution of the neurosciences and the ongoing importance of evidence-based prognostication in severe brain injury.

[German neurology and neurologists during the Third Reich: brain research and "euthanasia"]. / Neurologie und Neurologen in der NS-Zeit: Hirnforschung und "Euthanasie".

The connection between systematic killing of the mentally ill and disabled, euphemistically called "euthanasia" in the National Socialism ideology, and German brain research has been thoroughly investigated and in detail; however, the impact of this criminal nexus on the image and self-perception of German neurologists as well as the status of neurology as a medical discipline is still the subject of controversial debates.Between 1939 and 1945 the Kaiser Wilhelm Institute (KWI) in Berlin along with other research centres were insofar enmeshed in the "euthanasia" program as brains of killed patients were dissected in the guise of "concomitant research" in order to generate medical knowledge. Affected were mainly individuals suffering from oligophrenia, early childhood brain atrophy, cerebral palsy and epilepsy. According to current historical research, collegial networks were instrumental in receiving brains of killed patients. Furthermore, civil research units were supplemented by military ones at the KWI. These, too, were concerned with the collection of medical knowledge, for instance on injuries of the brain and spinal cord. The historical approach to consider the Nazi organizations and medicine as "resources for each other" seems, therefore, at least in part applicable to neurology.

Neurosurgical Work during the Napoleonic Wars: George James Guthrie's Experience.

Involved in what is still considered, along with the two world wars of the 20th century, as one of the major conflicts in Europe, George James Guthrie (1785-1856) was the most famous English army surgeon of the Napoleonic wars. After treating the injured throughout the Peninsular Campaign (1808-1814), in 1815 and then in 1842 he published two major books dealing with cranial and brain injuries, among other topics. In these books, we can find, for example, an early description of the plantar reflex further described by Joseph Babinsky, accurate descriptions of the clinical signs of intracranial hypertension, and details of the physiopathology of subdural and epidural haematomas. Skull fractures are also discussed intensively, along with the indications for trepanation, a much-debated issue at the turn of the 19th century. The dura was often the limit of the surgical field for Guthrie. Nevertheless, he tried to rationalize the use of trepanation and favoured its use in two main cases: in cases of depressed skull bones, jammed bone fragments or debris irritating the dura or the brain and in cases of life-threatening cerebral compression caused by supposed blood clots. In their works, Guthrie and his contemporaries did not address neurosurgery in the modern sense of the word, but rather 'cranial surgery' in most cases. Guthrie, who saw so many patients with brain injuries and amputations, failed to understand that cerebral functions could be localized to the cortex and neglected to describe the phantom limb phenomenon, as did most of his contemporaries.

A century of British military neurosurgery.

At the time of the Boer War in 1899 penetrating head injuries, which formed a large proportion of the battlefield casualties, resulted in almost 100% mortality. Since that time up to the present day, significant improvements in technique, equipment and organisation have reduced the mortality to about 10%.

Arthur Simons (1877-1942) and Tonic Neck Reflexes With Hemiplegic "Mitbewegungen" (Associated Reactions): Cinematography From 1916-1919.

Tonic neck reflexes were investigated by Rudolf Magnus and Adriaan de Kleijn in animals and men in 1912 and eventually by Arthur Simons, a neurologist in Berlin and coworker of Hermann Oppenheim. Simons studied these reflexes in hemiplegic patients, who were mainly victims of World War I. This work became his most important contribution and remained unsurpassed for many years. The film (Filmarchiv, Bundesarchiv [Film Archive, National Archive] Berlin) with Simons as an examiner shows 11 war casualties with brain lesions that occurred between 1916 and 1919. The injuries reveal asymmetric neck reflexes with "Mitbewegungen," that is, flexion or extension on the hemiplegic side. Mitbewegungen is identical with Francis Walshe's "associated reactions" caused by neck rotation and/or by cocontraction of the nonaffected extremities, for example, by closing of the fist (Walshe). The knowledge of the neck reflexes is important in acute neurology and in rehabilitation therapy of hemiplegics for antispastic positions. Simons' investigations were conducted in the early era of increasing use of cinematography in medical studies. The film had been nearly forgotten until its rediscovery in 2010.

A Physiologist's War: Captain T. Graham Brown RAMC (1915-1919).

During the five years before the outbreak of the First World War, Thomas Graham Brown (1882-1965) conducted research into the control of locomotion that gained him a deserved and long-lasting reputation as a neuroscientist and, in 1927, was recognized by election to the Fellowship of the Royal Society. In 1915, with the First World War raging, he agonized about continuing his research or joining the Royal Army Medical Corps (RAMC). Told by his father to seek a commission, he served two and half years in Macedonia with the British Salonika Force. Whilst in Greece, he kept a daily diary. The entries from June 1916 to May 1917 are extant. They are unpublished and provide the background to the narrative to follow. Casualties with traumatic injury to the brain and spinal cord afforded him the opportunity to carry out careful observations, particularly concerning sensory localization, which resulted in novel findings and his observations on shell shock led to him being called as an expert witness to the national inquiry into the nature and treatment of the condition. In 1920, Graham Brown was appointed to the Chair of Physiology in Cardiff, which he held until 1947.

The menace reflex.

The menace reflex (blink reflex to visual threat) tests visual processing at the bedside in patients who cannot participate in normal visual field testing. We reviewed a collection of recently discovered historical movies showing the experiments of the Dutch physiologist Gysbertus Rademaker (1887-1957), exploring the anatomy of this reflex by making cerebral lesions in dogs. The experiments show not only that the menace reflex is cortically mediated, but also that lesions outside the visual cortex can abolish the reflex. Therefore, although often erroneously used in this way, an absent menace does not always indicate a visual field deficit.

Battle for the mind: World War 1 and the birth of military psychiatry.

The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to acknowledge the origins of military psychiatry and the start of a journey from psychological ignorance to enlightenment. However, the psychiatric legacy of the war is ambiguous. During World War 1, a new disorder (shellshock) and a new treatment (forward psychiatry) were introduced, but the former should not be thought of as the first recognition of what is now called post-traumatic stress disorder and the latter did not offer the solution to the management of psychiatric casualties, as was subsequently claimed. For this Series paper, we researched contemporary publications, classified military reports, and casualty returns to reassess the conventional narrative about the effect of shellshock on psychiatric practice. We conclude that the expression of distress by soldiers was culturally mediated and that patients with postcombat syndromes presented with symptom clusters and causal interpretations that engaged the attention of doctors but also resonated with popular health concerns. Likewise, claims for the efficacy of forward psychiatry were inflated. The vigorous debates that arose in response to controversy about the nature of psychiatric disorders and the discussions about how these disorders should be managed remain relevant to the trauma experienced by military personnel who have served in Iraq and Afghanistan. The psychiatric history of World War 1 should be thought of as an opportunity for commemoration and in terms of its contemporary relevance-not as an opportunity for self-congratulation.

["A shot at the father: a student's assault". Sigmund Freud and the case of Ernst Haberl]. / "Ein Schuss gegen den Vater. Attentat eines Studenten" Sigmund Freud und der "Fall Ernst Haberl".

In the fall of 1922, the Freud family was involved in a criminal case: The son of Mathilde Freud's nursing sister, Ernst Haberl, had shot at his father. With the help of August Aichhorn the Viennese Juvenile Court's social assistance department was engaged on behalf of the young man. Freud commissioned the lawyer Valentin Teirich to defend him in court. The Viennese dailies reported the deed and the trial extensively (Haberl was acquitted). That a comment published in the Neue Freie Presse was written by Freud himself, as Teirich believed, is, according to Anna Freud, highly improbable.