Predictores de la recuperación funcional cognitiva en pacientes con traumatismo craneoencefálico / Predictors of the recovery of cognitive functions in patients with traumatic brain injury

Introducción. Tras un traumatismo craneoencefálico (TCE), el funcionamiento cognitivo de los pacientes puede resultar gravemente alterado. Diversos estudios han tratado de identificar las variables que mejor predicen su recuperación. Objetivos. Evaluar la recuperación funcional cognitiva de pacientes con TCE tras un programa de neurorrehabilitación e identificar las variables predictoras de dicha recuperación. Pacientes y métodos. Estudio pre-post retrospectivo de 58 pacientes adultos con TCE que realizaron un programa de rehabilitación intensivo. Todos fueron evaluados mediante la subescala de funcionalidad cognitiva de la medida de la independencia funcional + medida de la evaluación de la funcionalidad (FIM+FAM), al inicio y al final de la rehabilitación. Ambas puntuaciones fueron comparadas mediante la prueba no paramétrica de Wilcoxon. Se calculó el porcentaje de ganancia funcional cognitiva y se correlacionó con todas las variables recogidas. A partir de toda la información clínica, demográfica y cognitiva recogida, realizamos un análisis de regresión lineal múltiple para identificar los mejores predictores de dicha ganancia. Resultados. La funcionalidad cognitiva aumentó significativamente del 33,6% al 85% (p < 0,01). Los pacientes con mayor porcentaje de ganancia funcional cognitiva fueron aquellos con menor edad y período post-TCE, y mayores puntuaciones en la subescala cognitiva de la FIM+FAM y en las pruebas de atención condicional y curva de aprendizaje de Luria. Los mejores predictores de la recuperación funcional fueron el período post-TCE y la funcionalidad cognitiva al inicio (R2 ajustado = 55,8%). Conclusiones. El comienzo temprano de la rehabilitación y la mayor funcionalidad cognitiva al inicio resultaron ser los mejores predictores de la recuperación funcional cognitiva. Otras variables, como la edad o puntuaciones en pruebas cognitivas, también deben considerarse en futuros estudios (AU)

Introducción. After a traumatic brain injury (TBI), cognitive functionality may be severely altered. Some studies have aimed at identifying the best predictive variables for cognitive recovery, however, results still remain unclear. Aims: To assess the recovery of cognitive functionality in TBI patients after a rehabilitation programme, and to identify the variables that best predict the cognitive recovery. Patients and Methods: We conducted a retrospective pre-post study with 58 adult TBI patients that underwent an intensive rehabilitation programme. All of them were assessed using the cognitive functions sub-scale from the FIM+FAM scale, at admission and discharge. Both scores were compared using non-parametric test Wilcoxon. Cognitive functionality gain percentage was calculated and correlated with all the collected data. A multiple linear regression analysis was carried out to identify the best predictors of cognitive functionality gain percentage by introducing all clinical, demographic and cognitive information. Results. The group's cognitive functionality increased significantly from 33,6% to 85% (p < 0,01). Patients with higher cognitive functionality gain percentage were those with younger age, shorter time post-TBI, and higher scores on cognitive functions sub-scale, conditional attention and Luria's memory word tests. The best predictors for cognitive functionality gain percentage were time post-TBI and cognitive functions at admission (adjusted R2 = 55,8%). Conclusions:. Patients who started rehabilitation sooner and had a higher cognitive functionality at admission, showed the greatest increase in cognitive functionality gain percentage. Other variables like age, or scores on cognitive tests must also be considered in future studies (AU)

The sooner patients begin neurorehabilitation, the better their functional outcome.

PRIMARY OBJECTIVE: To determine whether early neurorehabilitation improves a patient's functional recovery. RESEARCH DESIGN: A retrospective study was carried out on patients with severe traumatic brain injury (TBI) who underwent a minimum of 4 months of integral and multidisciplinary neurorehabilitation. METHODS AND PROCEDURES: Fifty-eight patients with severe TBI were assessed at admission and at discharge using the FIM + FAM scale. Two groups were formed based on time elapsed from brain injury to onset of rehabilitation. The early treatment group (ET) included patients who began rehabilitation within the first 9 months post-trauma; the late treatment group (LT) began after the 9-month cut-off date. Intra- and between-group analysis of FIM + FAM scores were carried out at admission and discharge. Multiple linear regression was used to determine the best predictors for functional rehabilitation. MAIN OUTCOMES AND RESULTS: After neurorehabilitation, all subjects showed significant improvement in cognitive, motor, communication and psychosocial functioning. Moreover, the ET group showed better global functional outcome at discharge than patients who began later treatment. The best predictors for functional neurorehabilitation were months since injury, age, GCS score and months of treatment. CONCLUSIONS: It is concluded that the sooner patients begin neurorehabilitation, the better their functional outcome.