Guía: Principios básicos de la neurorrehabilitación del paciente con daño cerebral adquirido. Recomendaciones de la Sociedad Española de Neurorrehabilitación / Guidelines: Basic principles of neurorehabilitation for patients with acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation

Introducción: Guía para la práctica clínica en neurorrehabilitación de personas adultas con daño cerebral adquirido de la Sociedad Española de Neurorrehabilitación. Documento basado en la revisión de guías de práctica clínica internacionales publicadas entre 2013-2020. Desarrollo: Se establecen recomendaciones según el nivel de evidencia que ofrecen los estudios revisados referentes a aspectos consensuados entre expertos dirigidos a definir la población, características específicas de la intervención o la exposición bajo investigación. Conclusiones: Deben recibir neurorrehabilitación todos aquellos pacientes que, tras un daño cerebral adquirido, hayan alcanzado una mínima estabilidad clínica. La neurorrehabilitación debe ofrecer tanto tratamiento como sea posible en términos de frecuencia, duración e intensidad (al menos 45-60 minutos de cada modalidad de terapia específica que el paciente precise). La neurorrehabilitación requiere un equipo transdisciplinar coordinado, con el conocimiento, la experiencia y las habilidades para trabajar en equipo tanto con pacientes como con sus familias. En la fase aguda, y para los casos más graves, se recomiendan programas de rehabilitación en unidades hospitalarias, procediéndose a tratamiento ambulatorio tan pronto como la situación clínica lo permita y se puedan mantener los criterios de intensidad. La duración del tratamiento debe basarse en la respuesta terapéutica y en las posibilidades de mejoría, en función del mayor grado de evidencia disponible. Al alta deben ofrecerse servicios de promoción de la salud, actividad física, apoyo y seguimiento para garantizar que se mantengan los beneficios alcanzados, detectar posibles complicaciones o valorar posibles cambios en la funcionalidad que hagan necesario el acceso a nuevos programas de tratamiento.(AU)

Introduction: We present the Spanish Society of Neurorehabilitation's guidelines for adult acquired brain injury (ABI) rehabilitation. These recommendations are based on a review of international clinical practice guidelines published between 2013 and 2020. Development: We establish recommendations based on the levels of evidence of the studies reviewed and expert consensus on population characteristics and the specific aspects of the intervention or procedure under research. Conclusions: All patients with ABI should receive neurorehabilitation therapy once they present a minimal level of clinical stability. Neurorehabilitation should offer as much treatment as possible in terms of frequency, duration, and intensity (at least 45–60 min of each specific form of therapy that is needed). Neurorehabilitation requires a coordinated, multidisciplinary team with the knowledge, experience, and skills needed to work in collaboration both with patients and with their families. Inpatient rehabilitation interventions are recommended for patients with more severe deficits and those in the acute phase, with outpatient treatment to be offered as soon as the patient's clinical situation allows it, as long as intensity criteria can be maintained. The duration of treatment should be based on treatment response and the possibilities for further improvement, according to the best available evidence. At discharge, patients should be offered health promotion, physical activity, support, and follow-up services to ensure that the benefits achieved are maintained, to detect possible complications, and to assess possible changes in functional status that may lead the patient to need other treatment programmes.(AU)

Guidelines: basic principles of neurorehabilitation for patients with acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation.

INTRODUCTION: We present the Spanish Society of Neurorehabilitation's guidelines for adult acquired brain injury (ABI) rehabilitation. These recommendations are based on a review of international clinical practice guidelines published between 2013 and 2020. DEVELOPMENT: We establish recommendations based on the levels of evidence of the studies reviewed and expert consensus on population characteristics and the specific aspects of the intervention or procedure under research. CONCLUSIONS: All patients with ABI should receive neurorehabilitation therapy once they present a minimal level of clinical stability. Neurorehabilitation should offer as much treatment as possible in terms of frequency, duration, and intensity (at least 45-60minutes of each specific form of therapy that is needed). Neurorehabilitation requires a coordinated, multidisciplinary team with the knowledge, experience, and skills needed to work in collaboration both with patients and with their families. Inpatient rehabilitation interventions are recommended for patients with more severe deficits and those in the acute phase, with outpatient treatment to be offered as soon as the patient's clinical situation allows it, as long as intensity criteria can be maintained. The duration of treatment should be based on treatment response and the possibilities for further improvement, according to the best available evidence. At discharge, patients should be offered health promotion, physical activity, support, and follow-up services to ensure that the benefits achieved are maintained, to detect possible complications, and to assess possible changes in functional status that may lead the patient to need other treatment programmes.

Interacting humans use forces in specific frequencies to exchange information by touch.

Object-mediated joint action is believed to be enabled by implicit information exchange between interacting individuals using subtle haptic signals within their interaction forces. The characteristics of these haptic signals have, however, remained unclear. Here we analyzed the interaction forces during an empirical dyadic interaction task using Granger-Geweke causality analysis, which allowed us to quantify the causal influence of each individual's forces on their partner's. We observed that the inter-partner influence was not the same at every frequency. Specifically, in the frequency band of [2.15-7] Hz, we observed inter-partner differences of causal influence that were invariant of the movement frequencies in the task and present only when information exchange was indispensable for task performance. Moreover, the inter-partner difference in this frequency band was observed to be correlated with the task performance by the dyad. Our results suggest that forces in the [2.15-7] Hz band constitute task related information exchange between individuals during physical interactions.

[Effectiveness, adherence and usability of a teleneurorehabilitation programme to ensure continuity of care for patients with acquired brain injury during the COVID-19 pandemic]. / Efectividad, adhesión y usabilidad de un programa de teleneurorrehabilitación para garantizar la continuidad de cuidados en pacientes con daño cerebral adquirido durante la pandemia originada por la COVID-19.

INTRODUCTION: The health pandemic brought about by SARS-CoV-2 (COVID-19) has limited access to neurorehabilitation programmes for many patients who have suffered stroke, traumatic brain injury or acquired brain damage due to some other cause. As telerehabilitation allows for the provision of care in situations of social distancing, it may mitigate the negative effects of confinement. The aim of this study was to determine the efficacy, adherence and usability of a teleneurorehabilitation intervention for patients with acquired brain injury. PATIENTS AND METHODS: All patients included in a face-to-face neurorehabilitation programme at the time of the declaration of the state of alarm in Spain due to COVID-19 and who agreed to participate in the study were included in a teleneurorehabilitation programme. The effectiveness of the programme, understood as an improvement in independence, was quantified with the Barthel index. Adherence to the programme and usability of the tool were explored through questionnaires. RESULTS: Altogether, 46 patients, accounting for 70.6% of the total, participated in the study. Participants significantly improved their independence and showed an improvement in the Barthel index between the start (77.3 ± 28.6) and the end of the programme (82.3 ± 26). Adherence to the intervention was very high (8.1 ± 2.2 out of 10) and the online sessions were the most highly rated content. The tool used showed a high usability (50.1 ± 9.9 out of 60) and could be used without assistance by more than half the participants. CONCLUSION: The teleneurorehabilitation intervention was found to be effective in improving patients' independence, and promoted a high degree of adherence and usability.

TITLE: Efectividad, adhesión y usabilidad de un programa de teleneurorrehabilitación para garantizar la continuidad de cuidados en pacientes con daño cerebral adquirido durante la pandemia originada por la COVID-19.Introducción. La pandemia sanitaria originada por el SARS-CoV-2 (COVID-19) ha limitado el acceso a programas de neurorrehabilitación de muchos pacientes que han sufrido ictus, traumatismos craneoencefálicos o un daño cerebral adquirido por otra causa. Dado que la telerrehabilitación permite la provisión de cuidados en situaciones de distanciamiento social, podría atenuar los efectos negativos del confinamiento. El objetivo de este estudio fue determinar la eficacia, la adhesión y la usabilidad de una intervención de teleneurorrehabilitación dirigida a pacientes con daño cerebral adquirido. Pacientes y métodos. Todos los pacientes incluidos en un programa de neurorrehabilitación presencial en el momento de la declaración del estado de alarma en España con motivo de la COVID-19 y que aceptaron participar en el estudio fueron incluidos en un programa de teleneurorrehabilitación. La eficacia del programa, entendida como una mejora en la independencia, se cuantificó con el índice de Barthel. La adhesión al programa y la usabilidad de la herramienta se investigaron mediante cuestionarios. Resultados. Un total de 146 pacientes, el 70,6% del total, participó en el estudio. Los participantes mejoraron significativamente su independencia y mostraron una mejoría en el índice de Barthel entre el inicio (77,3 ± 28,6) y el fin del programa (82,3 ± 26). La intervención tuvo una gran adhesión (8,1 ± 2,2 sobre 10) y las sesiones en línea fueron el contenido mejor valorado. La herramienta utilizada mostró una elevada usabilidad (50,1 ± 9,9 sobre 60) y pudo ser utilizada sin ayuda por más de la mitad de los participantes. Conclusión. La intervención de teleneurorrehabilitación resultó ser eficaz para mejorar la independencia de los pacientes, y promovió una elevada adhesión y usabilidad.

Efectividad, adhesión y usabilidad de un programa de teleneurorrehabilitación para garantizar la continuidad de cuidados en pacientes con daño cerebral adquirido durante la pandemia originada por la COVID-19 / Effectiveness, adherence and usability of a teleneurorehabilitation programme to ensure continuity of care for patients with acquired brain injury during the COVID-19 pandemic

Introducción: La pandemia sanitaria originada por el SARS-CoV-2 (COVID-19) ha limitado el acceso a programas de neurorrehabilitación de muchos pacientes que han sufrido ictus, traumatismos craneoencefálicos o un daño cerebral adquirido por otra causa. Dado que la telerrehabilitación permite la provisión de cuidados en situaciones de distanciamiento social, podría atenuar los efectos negativos del confinamiento. El objetivo de este estudio fue determinar la eficacia, la adhesión y la usabilidad de una intervención de teleneurorrehabilitación dirigida a pacientes con daño cerebral adquirido. Pacientes y métodos: Todos los pacientes incluidos en un programa de neurorrehabilitación presencial en el momento de la declaración del estado de alarma en España con motivo de la COVID-19 y que aceptaron participar en el estudio fueron incluidos en un programa de teleneurorrehabilitación. La eficacia del programa, entendida como una mejora en la independencia, se cuantificó con el índice de Barthel. La adhesión al programa y la usabilidad de la herramienta se investigaron mediante cuestionarios. Resultados: Un total de 146 pacientes, el 70,6% del total, participó en el estudio. Los participantes mejoraron significativamente su independencia y mostraron una mejoría en el índice de Barthel entre el inicio (77,3 ± 28,6) y el fin del programa (82,3 ± 26). La intervención tuvo una gran adhesión (8,1 ± 2,2 sobre 10) y las sesiones en línea fueron el contenido mejor valorado. La herramienta utilizada mostró una elevada usabilidad (50,1 ± 9,9 sobre 60) y pudo ser utilizada sin ayuda por más de la mitad de los participantes. Conclusión: La intervención de teleneurorrehabilitación resultó ser eficaz para mejorar la independencia de los pacientes, y promovió una elevada adhesión y usabilidad.(AU)

Introduction: The health pandemic brought about by SARS-CoV-2 (COVID-19) has limited access to neurorehabilitation programmes for many patients who have suffered stroke, traumatic brain injury or acquired brain damage due to some other cause. As telerehabilitation allows for the provision of care in situations of social distancing, it may mitigate the negative effects of confinement. The aim of this study was to determine the efficacy, adherence and usability of a teleneurorehabilitation intervention for patients with acquired brain injury. Patients and methods: All patients included in a face-to-face neurorehabilitation programme at the time of the declaration of the state of alarm in Spain due to COVID-19 and who agreed to participate in the study were included in a teleneurorehabilitation programme. The effectiveness of the programme, understood as an improvement in independence, was quantified with the Barthel index. Adherence to the programme and usability of the tool were explored through questionnaires. Results: Altogether, 46 patients, accounting for 70.6% of the total, participated in the study. Participants significantly improved their independence and showed an improvement in the Barthel index between the start (77.3 ± 28.6) and the end of the programme (82.3 ± 26). Adherence to the intervention was very high (8.1 ± 2.2 out of 10) and the online sessions were the most highly rated content. The tool used showed a high usability (50.1 ± 9.9 out of 60) and could be used without assistance by more than half the participants. Conclusion: The teleneurorehabilitation intervention was found to be effective in improving patients’ independence, and promoted a high degree of adherence and usability.(AU)

Validez actual del diagnóstico de «estado vegetativo permanente»: estudio longitudinal en una muestra clínica de pacientes en estados alterados de conciencia / Current validity of diagnosis of permanent vegetative state: A longitudinal study in a sample of patients with altered states of consciousness

INTRODUCCIÓN: Los estados alterados de conciencia han sido considerados tradicionalmente como cuadros clínicos de pronóstico infausto. En la actualidad, sabemos que dichos estados engloban distintas entidades clínicas cuyo perfil diferencial empieza a reconocerse. MÉTODO: Se incluyeron 37 pacientes con el diagnóstico de estado vegetativo o síndrome de vigilia sin respuesta (SVSR) y 43 en estado de mínima conciencia (EMC) de acuerdo con la Coma Recovery Scale-Revised (CRS-R). Todos los pacientes fueron evaluados mensualmente con la CRS-R durante al menos 6 meses. Se evaluó el momento de superar cada estado considerando los puntos de corte de «irreversibilidad» (12 meses para los casos de origen traumático y 3 para los no traumáticos), tradicionalmente establecidos por la Multi-Society-Task-Force. Se empleó un modelo de regresión logística para determinar las variables predictoras de superar el EMC. RESULTADOS: Un total de 23 pacientes en SVSR superaron este estado, pero solo 9superaron el EMC. De los 43 pacientes en EMC al ingreso, 26 lograron superarlo. Ocho de los 23 (34,7%) pacientes que superaron el SVSR y 17 de los 35 (48,6%) que superaron el EMC lo hicieron más allá del punto de «irreversibilidad». La etiología (p < 0,01), la cronicidad (p = 0,01) y la puntuación en la CRS-R (p < 0,001) predijeron la salida de EMC en el modelo multivariante con un 77,5% de acierto. CONCLUSIONES: Tanto el SVRS como el EMC son entidades clínicamente diferenciadas en términos diagnósticos y pronósticos. Algunos criterios clásicos relacionados con el mal pronóstico de estos estados en términos de tiempo y posibilidades de recuperación deben ser reevaluados

INTRODUCTION: Altered states of consciousness have traditionally been associated with poor prognosis. At present, clinical differences between these entities are beginning to be established. METHOD: Our study included 37 patients diagnosed with vegetative state/unresponsive wakefulness syndrome (UWS) and 43 in a minimally conscious state (MCS) according to the Coma Recovery Scale-Revised (CRS-R). All patients were followed up each month for at least 6 months using the CRS-R. We recorded the time points when vegetative state progressed from 'persistent' to 'permanent' based on the cut-off points established by the Multi-Society-Task-Force: 12 months in patients with traumatic injury and 3 months in those with non-traumatic injury. A logistic regression model was used to determine the factors potentially predicting which patients will emerge from MCS. RESULTS: In the UWS group, 23 patients emerged from UWS but only 9 emerged from MCS. Of the 43 patients in the MCS group, 26 patients emerged from that state during follow-up. Eight of the 23 patients (34.7%) who emerged from UWS and 17 of the 35 (48.6%) who emerged from MCS recovered after the time points proposed by the Multi-Society-Task-Force. According to the multivariate regression analysis, aetiology (P < .01), chronicity (P = .01), and CRS-R scores at admission (P < .001) correctly predicted emergence from MCS in 77.5% of the cases. CONCLUSIONS: UWS and MCS are different clinical entities in terms of diagnosis and outcomes. Some of the factors traditionally associated with poor prognosis, such as time from injury and likelihood of recovery, should be revaluated

Current validity of diagnosis of permanent vegetative state: A longitudinal study in a sample of patients with altered states of consciousness. / Validez actual del diagnóstico de «estado vegetativo permanente¼: estudio longitudinal en una muestra clínica de pacientes en estados alterados de conciencia.

INTRODUCTION: Altered states of consciousness have traditionally been associated with poor prognosis. At present, clinical differences between these entities are beginning to be established. METHOD: Our study included 37 patients diagnosed with vegetative state/unresponsive wakefulness syndrome (UWS) and 43 in a minimally conscious state (MCS) according to the Coma Recovery Scale-Revised (CRS-R). All patients were followed up each month for at least 6 months using the CRS-R. We recorded the time points when vegetative state progressed from 'persistent' to 'permanent' based on the cut-off points established by the Multi-Society-Task-Force: 12 months in patients with traumatic injury and 3 months in those with non-traumatic injury. A logistic regression model was used to determine the factors potentially predicting which patients will emerge from MCS. RESULTS: In the UWS group, 23 patients emerged from UWS but only 9 emerged from MCS. Of the 43 patients in the MCS group, 26 patients emerged from that state during follow-up. Eight of the 23 patients (34.7%) who emerged from UWS and 17 of the 35 (48.6%) who emerged from MCS recovered after the time points proposed by the Multi-Society-Task-Force. According to the multivariate regression analysis, aetiology (P<.01), chronicity (P=.01), and CRS-R scores at admission (P<.001) correctly predicted emergence from MCS in 77.5% of the cases. CONCLUSIONS: UWS and MCS are different clinical entities in terms of diagnosis and outcomes. Some of the factors traditionally associated with poor prognosis, such as time from injury and likelihood of recovery, should be revaluated.

Eficacia del sistema Armeo ®Spring en la fase crónica del ictus. Estudio en hemiparesias leves-moderadas / Efficacy of Armeo ®Spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis

Objetivo: Valorar la eficacia del sistema Armeo®Spring para la rehabilitación del miembro superior en pacientes crónicos que han presentado un ictus. Material y métodos: Veintitrés pacientes (17 varones y 6 mujeres), con una edad media ± desviación estándar de 54,6 ± 9,5 años, que presentaban una hemiparesia crónica (cronicidad de 328 ± 90,8 días) secundaria a ictus isquémico (n = 12) o hemorrágico (n = 11), se incluyeron en este estudio. Todos los pacientes completaron 36 sesiones de una hora de duración con el sistema Armeo®Spring y fueron valorados al inicio, al fin y 4 meses después de completar el tratamiento con escalas dirigidas a los dominios de estructura, función y actividad de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) incluyendo: Ashworth Modified Scale, Motricity Index (MI), Fugl-Meyer ssessment Scale (FM), Motor Assessment Scale (MAS), Manual Function Test (MFT) y Wolf Motor Function (WMFT). Resultados: Un ANOVA de medidas repetidas mostró una mejoría significativa (efecto tiempo) en todas las escalas de función (p < 0,01 en FM y MI) y actividad (p < 0,01 en MAS, MFT, WMFT Habilidad y p < 0,05 en WMFT-tiempo), sin que se apreciaran cambios significativos en el tono muscular. El estudio post hoc (Bonferroni) mostró un patrón de evolución diferente entre las escalas de función y las de actividad, con un beneficio directamente ligado al entrenamiento, especialmente en las escalas de actividad. Conclusiones: El Armeo®Spring constituye una herramienta eficaz para la rehabilitación del miembro superior afectado en pacientes con una hemiparesia debida a un ictus, incluso en estadios crónicos (AU)

Objective: To evaluate the efficacy of a gravity-supported, computer-enhanced device (Armeo®Spring) for upper limb rehabilitation in chronic stroke patients. Material and methods: We included 23 chronic hemiparetic patients (chronicity: 328 ± 90.8 days; distribution: 17 men and 6 women) aged 54.6 ± 9.5 years, who had sustained ischaemic stroke (n = 12) or haemorrhagic stroke (n = 11). All patients completed 36 one-hour sessions using the Armeo®Spring system. Arm movement was assessed at the beginning and end of the treatment programme and once more 4 months later. Main outcome measurements covered structure, activity, and function, as per the International Classification of Functioning, Disability and Health: Modified Ashworth Scale, Motricity Index (MI), Fugl-Meyer Assessment Scale (FM), Motor Assessment Scale (MAS), Manual Function Test (MFT), and Wolf Motor Function Test (WMFT). Results: Repeated measures ANOVA showed significant improvement (time effect) for all function scales (P < .01 for FM and MI) and activity scales (P<.01 for MAS, MFT and WMFT-ability, and P < .05 WMFT-time) without significant changes in muscle tone. The post-hoc analysis (Bonferroni) showed different evolutionary patterns for function and activity measurements, and clear benefits related to Armeo®Spring training, especially on activity scales. Conclusions: Armeo®Spring is an effective tool for rehabilitating the affected arm in patients with hemiparesis secondary to ictus, even in the chronic stage (AU)

Efficacy of Armeo® Spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis.

OBJECTIVE: To evaluate the efficacy of a gravity-supported, computer-enhanced device (Armeo® Spring) for upper limb rehabilitation in chronic stroke patients. MATERIAL AND METHODS: We included 23 chronic hemiparetic patients (chronicity: 328 ± 90.8 days; distribution: 17 men and 6 women) aged 54.6 ± 9.5 years, who had sustained ischaemic stroke (n=12) or haemorrhagic stroke (n=11). All patients completed 36 one-hour sessions using the Armeo® Spring system. Arm movement was assessed at the beginning and end of the treatment programme and once more 4 months later. Main outcome measurements covered structure, activity, and function, as per the International Classification of Functioning, Disability and Health: Modified Ashworth Scale, Motricity Index (MI), Fugl-Meyer Assessment Scale (FM), Motor Assessment Scale (MAS), Manual Function Test (MFT), and Wolf Motor Function Test (WMFT). RESULTS: Repeated measures ANOVA showed significant improvement (time effect) for all function scales (P<.01 for FM and MI) and activity scales (P<.01 for MAS, MFT and WMFT-ability, and P<.05 WMFT-time) without significant changes in muscle tone. The post-hoc analysis (Bonferroni) showed different evolutionary patterns for function and activity measurements, and clear benefits related to Armeo® Spring training, especially on activity scales. CONCLUSIONS: Armeo® Spring is an effective tool for rehabilitating the affected arm in patients with hemiparesis secondary to ictus, even in the chronic stage.

Predictores clínicos de marcha independiente en pacientes con traumatismo craneoencefálico severo / Clinical predictors of independent ambulation after severe traumatic brain injury

Objetivo. Identificar los predictores clínicos de marcha independiente en pacientes con traumatismo craneoencefálico (TCE) severo tras un programa de rehabilitación multidisciplinario y determinar la correlación entre los resultados de la rehabilitación y el estado neurológico del paciente al ingreso. Pacientes y métodos. Análisis retrospectivo de una muestra de 73 pacientes con TCE severo y sin capacidad de marcha al ingreso, seguidos longitudinalmente durante un período medio de 215,3±85,9 días. Todos ellos fueron clasificados en función de su estado neurológico al ingreso: estado vegetativo (EV, n=14), estado de mínima conciencia (EMC, n=16), amnesia postraumática (APT, n=30) y fuera de APT (n=13). Resultados. De forma general, el 41,1% de la muestra adquirió capacidad de marcha al finalizar el programa de rehabilitación multidisciplinario específico. En función del estado neurológico de los pacientes al ingreso, 3 pacientes (18,8%) del grupo de EMC, 17 pacientes (56,7%) del grupo de APT y 10 pacientes (76,9%) del grupo fuera de APT lograron realizar una marcha independiente. Ninguno de los pacientes clasificados inicialmente en EV fue capaz de andar de forma independiente. El modelo de regresión logística reveló que el estado neurológico general (p<0,001), la cronicidad (p=0,001) y la movilidad axial al ingreso evaluada con el Rivermead Mobility Index (p=0,02) fueron predictores independientes de marcha. Discusión. El estado neurológico general, el tiempo transcurrido desde la lesión y la movilidad general al ingreso pueden ayudar a predecir la recuperación de la capacidad de marcha independiente tras un programa de rehabilitación en esta población(AU)

Objective. To identify clinical predictors of independent ambulation in patients with severe traumatic brain injury (TBI) after a multidisciplinary rehabilitation program and to determine the correlation between rehabilitation outcomes and neurological status of the patient on admission. Patients and methods. A retrospective analysis of a sample of 73 patients with severe head injury and no ability to walk on admission, followed longitudinally for an average of 215.3±85.9days, was performed. All patients were classified into four groups based on their neurological status at admission: vegetative state (n=14), minimally conscious state (n=16), post-traumatic amnesia (PTA, n=30) and out-of-PTA (n=13). Results. Globally, 41.1% of the initial sample acquired gait abilities after specific multidisciplinary rehabilitation. Regarding neurological status at admission, three patients (18.8%) of the minimally conscious group, 17 patients (56.7%) of the PTA group, 10 patients (76.9%) of the out-of-PTA group, and none of the patients who were initially classified in the vegetative state group were able to walk independently after 6 months. The final multivariate logistic regression model revealed that global neurological status (p<0.001), chronicity (p=0.001), and Rivermead Mobility Index (p=0.02) were independent predictors of gait. Discussion. Global neurological status, time since injury, and global mobility at admission can help predict recovery of independent gait after six months of rehabilitation in this population(AU)

eBaViR, easy balance virtual rehabilitation system: a study with patients.

eBaViR is a virtual rehabilitation system, which has been developed for balance rehabilitation for patients suffering from acquired brain injury. It is a game-based system that uses a low-cost interface, the Nintendo Wii Balance Board. The games have been specifically designed with the help of experts in the rehabilitation of balance disorders and can be adapted to patients according to their needs. We present an experimental study that has been carried out using the system. The aim of the study is to determine whether this setup could be applied as a Virtual Rehabilitation System for balance rehabilitation in Acquired Brain Injury. We randomly divided patients into two groups: a trial group and a control group. The trial group used eBaViR system during the rehabilitation sessions, and the control group followed traditional rehabilitation sessions. We obtained encouraging results.

APOE genotype and verbal memory recovery during and after emergence from post-traumatic amnesia.

OBJECTIVE: To determine if APOE genotype is linked to memory function after moderate-severe traumatic brain injury (TBI). METHODS: Eighty-two patients in post-traumatic amnesia (PTA) and 107 patients who had emerged from PTA were selected from 239 consecutive patients admitted to the facility. Verbal memory assessments, including the Spanish version of the California Verbal Learning Test and the Working-Memory Index of the WAIS-III, were conducted immediately after PTA resolution or during the first week after admission for patients who were out of PTA. Both groups were reassessed 6 months after inclusion in a multidisciplinary rehabilitation programme. RESULTS: Patients with the APOE-epsilon 4 allele (n = 17 in the PTA group and n = 9 in the out of PTA group) entered rehabilitation at a more impaired level, but made remarkable progress during follow-up. Fifty-five patients from the initial sample emerged from PTA during the follow-up period. Age, GOAT at admission and chronicity, but not APOE genotype or initial trauma severity, were significant predictors of emergence from PTA. CONCLUSIONS: APOE genotype seems to be associated with the trajectory of cognitive recovery after TBI, but does not play a determinant role in the efficacy of memory rehabilitation in this population.

Priorities for cancer control in Spain.

Spanish cancer strategy is being developed in the context of a decentralised health care system. The advantages and challenges posed by this system are reviewed, particularly vis-à-vis the need to build consensus among regional health services as regards priorities in cancer control. Analysis of the impact of cancer in Spain enables smoking prevention and obesity reduction to be highlighted, especially among adolescents, as targets for primary prevention. Two-yearly colorectal cancer screening using the faecal occult blood test and targeting persons aged 50-69 years is a new goal that should be pursued countrywide, as should population-based breast cancer screening. Insofar as health care is concerned, the focus is on promoting and consolidating multidisciplinary cancer care based on evidence-based clinical guidelines, and on ensuring that cancer patients enjoy prompt access to diagnosis and therapy. Psychosocial support, with experience gained in several health services, should be expanded. Palliative care must be consolidated as a necessary therapy for patients who require it. Finally, the important boost to cancer research witnessed in recent years should be sustained. The approach adopted is based on building a co-operative strategy among all of Spain's autonomous regions (Comunidades Autónomas), which must then apply the interventions in their respective health services. A shared understanding of the main priorities for cancer control, through a review of the evidence and a consensus embracing all stakeholders, including scientific societies and patients' associations, is an essential step in the implementation of cancer strategy in Spain.

[Cross-cultural adaptation and validation of the Cambridge Depersonalisation Scale]. / Adaptación y validación al castellano de la Escala de Despersonalización de Cambridge.

INTRODUCTION: The Cambridge Depersonalisation Scale (CDS) is a self-rating questionnaire constructed to capture the frequency and duration of depersonalization symptoms over the last six months. The instrument has proved to be valid and reliable and can be useful in both clinical and neurobiological research. METHODS: This paper presents the Spanish adaptation and validation of the CDS. The study was carried out in two stages. First, we developed the Spanish version of the CDS by means of a cross-cultural adaptation methodology. Second, the CDS was tried on a sample of 130 subjects: 77 patients meeting DSM-IV-TR criteria for schizophrenia, 35 with depression disorders and 18 with anxiety disorders. Scores were compared against clinical diagnoses (gold standard). Furthermore, all the subjects of the study were administered the following: Dissociation Experiences Scale (DES), Positive and Negative Syndrome Scale (PANSS), Beck's Depression Inventory (BDI), and the Hamilton Anxiety Rating Scale (HARS). RESULTS: 38 patients (29.2 %) had depersonalization symptoms. The scale showed high internal consistency (Cronbach's alpha > 0.9 and split-half reliability > 0.8) and a test-retest reliability of 0.391. Convergent validity was 0.65 (p < 0.001) and discriminant validity was 0.308 (p < 0.05). The area under the ROC curve was 0.94. A cut-off of 71 appears to be most useful (sensitivity and specificity were 76.3 % and 89.1 %, respectively). CONCLUSION: The Spanish version of the CDS has good reliability and validity, similar to the original instrument.

Adaptación y validación al castellano de la Escala de Despersonalización de Cambridge / Cross-cultural adaptation and validation of the Cambridge Depersonalisation Scale

Introducción. La Escala de Despersonalización de Cambridge (CDS) es un cuestionario autoadministrado construido para capturar la frecuencia y duración de los síntomas de despersonalización en los últimos 6 meses. El instrumento ha mostrado ser válido y fiable y puede ser útil tanto en la clínica como en la investigación neurobiológica. Métodos. Este trabajo presenta la adaptación y validación al castellano de la CDS. El estudio fue llevado a cabo en dos etapas. En la primera desarrollamos la versión española de la CDS siguiendo la metodología de adaptación transcultural. En la segunda la CDS fue aplicada en una muestra de 130 sujetos: 77 pacientes reunieron criterios del DSM-IV-TR para esquizofrenia, 35 con trastorno depresivo y 18 con trastorno de ansiedad. Las puntuaciones obtenidas fueron comparadas con el diagnóstico clínico (patrón oro). Además, todos los sujetos del estudio completaron los cuestionarios Escala de Experiencias Disociativas (DES), Escala de los Síndromes Positivo y Negativo (PANSS), Inventario de Depresión de Beck (BDI) y Escala de Ansiedad de Hamilton (HARS). Resultados. Treinta y ocho pacientes (29,2 %) presentaron síntomas de despersonalización. La escala mostró una consistencia interna elevada (alfa de Cronbach > 0,9 y fiabilidad al dividir por la mitad [split-half reliability], > 0,8) y una fiabilidad test-retest de 0,391. La validez convergente fue de 0,65 (p < 0,001) y la discriminativa fue de 0,308 (p < 0,05). El área bajo la curva ROC fue de 0,94. El punto de corte de 71 pareció ser el más favorable (la sensibilidad y especificidad fueron 76,3 y 89,1 %, respectivamente). Conclusión. La versión al castellano de la CDS ha mostrado una validez y fiabilidad aceptables, similares a las del cuestionario original

Introduction. The Cambridge Depersonalisation Scale (CDS) is a self-rating questionnaire constructed to capture the frequency and duration of depersonalization symptoms over the last six months. The instrument has proved to be valid and reliable and can be useful in both clinical and neurobiological research. Methods. This paper presents the Spanish adaptation and validation of the CDS. The study was carried out in two stages. First, we developed the Spanish version of the CDS by means of a cross-cultural adaptation methodology. Second, the CDS was tried on a sample of 130 subjects: 77 patients meeting DSM-IV-TR criteria for schizophrenia, 35 with depression disorders and 18 with anxiety disorders. Scores were compared against clinical diagnoses (gold standard). Furthermore, all the subjects of the study were administered the following: Dissociation Experiences Scale (DES), Positive and Negative Syndrome Scale (PANSS), Beck's Depression Inventory (BDI), and the Hamilton Anxiety Rating Scale (HARS). Results. 38 patients (29.2 %) had depersonalization symptoms. The scale showed high internal consistency (Cronbach's alpha > 0.9 and split-half reliability > 0.8) and a test-retest reliability of 0.391. Convergent validity was 0.65 (p < 0.001) and discriminant validity was 0.308 (p < 0.05). The area under the ROC curve was 0.94. A cut-off of 71 appears to be most useful (sensitivity and specificity were 76.3 % and 89.1 %, respectively). Conclusion. The Spanish version of the CDS has good reliability and validity, similar to the original instrument

[Abbreviating the brief. Approach to ultra-short versions of the Yesavage questionnaire for the diagnosis of depression]. / Abreviar lo breve. Aproximación a versiones ultracortas del cuestionario de Yesavage para el cribado de la depresión.

OBJECTIVES: To assess the validity of small questionnaires of 4,5 and 1 questions, based on the 15-question Spanish version of the Yesavage geriatric depression scale (GDS-VE), for diagnosing depression in the over-65s. DESIGN: Study to validate questionnaires. SETTING: Health centre consultations. PARTICIPANTS: 258 patients were selected to adapt and validate the original questionnaire (GDS-15). Then validity data were assessed by using a group with one question (GDS-1), a group with 4 questions (GDS-4) and a group with 5 (GDS-5). The questions were chosen for the greater sensitivity and specificity shown in the validation study of the GDS-VE. MAIN MEASUREMENTS: Inter and intra-observer reliability, internal consistency, convergent validity (Spearman's correlation coefficient: CC), criterion validity (sensitivity, S, and specificity, E), and the diagnostic capacity of each questionnaire (area under the ROC curve: AUC), at their respective 95% confidence intervals (CI), were all analysed. RESULTS: 249 patients concluded the study, with the following results (the cut-off point was taken as 2 or more points on the 4 and 5-question versions): GDS-1: S: 71.1% (61.7-80.4), E: 74.1% (67.3-80.9), AUC: 0.726 (0.659-0.793), CC: 0.679 (0.673-0.684). GDS-4: S: 73.3% (64.2-82.4), E: 77.7% (71.2-84.2), AUC: 0.821 (0.765-0.876), CC: 0.803 (0.754-0.852). GDS-5: S: 81.1% (73.1-89.1), E: 73.2% (66.3-80.1), AUC: 0.833 (0.789-0.887), CC: 0.866 (0.824-0.908). CONCLUSIONS: The sensitivity and specificity results are similar to results of other ultra-short GDS studies. The high reliability of these ultra-short versions leads us to recommend that new studies be run to enable these versions to be consolidated as a valid and very rapid option for diagnosing depression among the elderly.

Abreviar lo breve. Aproximación a versiones ultracortas del cuestionario de Yesavage para el cribado de la depresión / Abbreviating the brief. Approach to ultra-short versions of the yesavage questionnaire for the diagnosis of depression

Objetivo. Evaluar la validez de cuestionarios reducidos de 4,5 y 1 preguntas basados en la escala geriátrica de depresión de Yesavage en su versión española (GDS-VE) de 15 preguntas, para el cribado de la depresión en las personas > 65 años. Diseño. Estudio de validación de cuestionarios. Emplazamiento. Consultas de un centro de salud. Participantes. Se seleccionó a 258 pacientes para adaptar y validar el cuestionario original (GDS-15). Posteriormente se valoran los datos de validez al aplicar un grupo de 1 pregunta (GDS-1), 4 preguntas (GDS-4) y otro de 5 (GDS-5)seleccionadas por su mayor sensibilidad y especificidad obtenidas en el estudio de validación del GDS-VE. Mediciones principales. Se analiza la fiabilidad inter-observador e intraobservador, la consistencia interna, la validez convergente (coeficiente de correlación de Spearman [CC]), la validez de criterio (sensibilidad [S] y especificidad [E]) y la capacidad diagnóstica de cada cuestionario (área bajo la curva ROC [AUC]), con los respectivos intervalos de confianza (IC) del95%.Resultados. Finalizaron el estudio 249pacientes. Se han obtenido los siguientes resultados, considerando un punto de corte de ≥ 2 en las versiones de 4 y 5 preguntas:- GDS-1: S del 71,1% (61,7-80,4); E del74,1% (67,3-80,9); AUC = 0,726 (0,659-0,793); CC = 0,679 (0,673-0,684).- GDS-4: S del 73,3% (64,2-82,4); E del77,7% (71,2-84,2); AUC = 0,821 (0,765-0,876); CC = 0,803 (0,754-0,852).- GDS-5: S del 81,1% (73,1-89,1); E del73,2% (66,3-80,1); AUC = 0,833 (0,789-0,887); CC = 0,866 (0,824-0,908).Conclusiones. Los resultados de sensibilidad y especificidad son similares a los obtenidos en otros estudios de GDS ultracorta. La buena fiabilidad de estas versiones ultracortas nos hace recomendar la realización de nuevos trabajos que permitan consolidarlo como una opción válida y muy rápida para el cribado de la depresión en población anciana

Objetives. To assess the validity of small questionnaires of 4,5 and 1 questions, based on the 15-question Spanish version of the Yesavage geriatric depression scale (GDSVE),for diagnosing depression in the over-65s.Design. Study to validate questionnaires. Setting. Health centre consultations. Participants. 258 patients were selected to adapt and validate the original questionnaire(GDS-15). Then validity data were assessed by using a group with one question (GDS-1),a group with 4 questions (GDS-4) and a group with 5 (GDS-5). The questions were chosen for the greater sensitivity and specificity shown in the validation study of the GDS-VE. Main measurements. Inter and intra-observer reliability, internal consistency, convergent validity (Spearman’s correlation coefficient: CC), criterion validity (sensitivity, S, and specificity, E), and the diagnostic capacity of each questionnaire (area under the ROCcurve: AUC), at their respective 95%confidence intervals (CI), were all analysed. Results. 249 patients concluded the study, with the following results (the cut-off point was taken as 2 or more points on the 4 and5-question versions): GDS-1: S: 71.1% (61.7-80.4), E: 74.1% (67.3-80.9), AUC: 0.726(0.659-0.793), CC: 0.679 (0.673-0.684).GDS-4: S: 73.3% (64.2-82.4), E: 77.7%(71.2-84.2), AUC: 0.821 (0.765-0.876), CC:0.803 (0.754-0.852).GDS-5: S: 81.1% (73.1-89.1), E: 73.2%(66.3-80.1), AUC: 0.833 (0.789-0.887), CC:0.866 (0.824-0.908).Conclusions. The sensitivity and specificity results are similar to results of other ultrashort GDS studies. The high reliability of these ultra-short versions leads us to recommend that new studies be run to enable these versions to be consolidated as a valid and very rapid option for diagnosing depression among the elderly

Versión española del cuestionario de Yesavage abreviado (GDS) para el despistaje de depresión en mayores de 65 años: adaptación y validación / The Spanish version of the Yesavage abbreviated questionnaire (GDS) to screen depressive dysfunctions in patients older than 65 years

Fundamento: existen escasos cuestionarios de cribado de depresión adecuadamente validados al castellano. Objetivo: adaptar y validar al castellano la versión abreviada de la Geriatric Depression Scale de Yesavage (GDS) para su uso en el cribado de depresiones en mayores de 65 años. Diseño, material y método: el trabajo se ha realizado en consultas de un centro de salud de Atención Primaria mediante un estudio de validación de cuestionarios. Se ha realizado en tres etapas: en la primera se ha traducido y adaptado el cuestionario al castellano (GDS-VE). En una segunda fase el médico/enfermera de cada sujeto aplicó el cuestionario de forma individual. Por último, otro investigador, de forma ciega, realizó al sujeto una entrevista semiestructurada para determinar síntomas de depresión según los criterios establecidos en la CIE-10. Igualmente se realizó una evaluación del estado cognitivo y se cumplimentaron los cuestionarios de Montgomery - Asberg, Pfeiffer- VE , MEC, IQCODE-VE y la parte de valoración de actividades de la vida diaria del OARS-MFAQ. El resultado final de esta exploración fue considerado como el patrón oro de diagnóstico de depresión, siendo la referencia para el cálculo de la sensibilidad, especificidad y razones de máxima verosimilitud para un resultado positivo y negativo del test. Resultados: se ha realizado la adaptación del GDS obteniendo la versión a validar (GDS-VE).Finalizaron el estudio 249 personas mayores de 65 años, con media de edad de 74,3 años, el 67,5 per cent mujeres y un 65 per cent analfabetos o sin estudios. La fiabilidad intraobservador ha sido del 0,95 y la interobservador del 0,65, con una consistencia interna de 0,99. Se ha obtenido un área bajo la curva de 0,835. La sensibilidad alcanzada ha sido del 81,1 per cent y la especificidad del 76,7 per cent para un punto de corte de 5 o más puntos. Conclusiones: los parámetros de fiabilidad y validez para la versión adaptada han resultado aceptables y similares a los del cuestionario original. Se recomienda utilizar un punto de corte de 5 o más para considerar la posible existencia de depresión (AU)

[Spanish language adaptation and validation of the Pfeiffer's questionnaire (SPMSQ) to detect cognitive deterioration in people over 65 years of age]. / Adaptación y validación al castellano del cuestionario de Pfeiffer (SPMSQ) para detectar la existencia de deterioro cognitivo en personas mayores de 65 años.

BACKGROUND: Our aims were to develop a Spanish version of the short portable mental status questionnaire (SPMSQ) (Pfeiffer's test) and to validate the resultant Spanish version of the test among a general population aged 65 years or older. PATIENTS, MATERIAL AND METHODS: First, we developed the Spanish version of the SPMSQ by means of a cross-cultural adaptation methodology. Patients were the assessed by independent teams in two sessions the same day. The first team (two trained psychiatrists and one trained family physician) carried out a standardised neuropsychological assessment to diagnose cognitive impairment/dementia according to ICD-10 criteria which was regarded as the reference "gold standard" to calculate validity parameters (sensitivity and specificity). The second team (family physicians/nurses) assessed the presence of cognitive impairment with the Spanish version of the SPMSQ. RESULTS: 255 subjects (66.7%, females) underwent the assessment. Mean age was 74.5 years and 65.5% of them were illiterate. The inter-rater reliability and test-retest reliability of the SPMSQ Spanish version were 0.738 (p < 0.001), and 0.925 (p < 0.001), respectively,with a convergent validity of 0.74 (p < 0.001) and a discriminant validity of 0.230 (p < 0.001). The internal consistency was high with an *value of 0.82. The area under the ROC curve was 0.89. Sensitivity and specificity were 85.7 and 79.3, respectively (cut-off of 3 or more). CONCLUSIONS: The Spanish version of the SPMSQ test has a good reliability and validity. For clinical use, a cut-off of 3 appears to be most useful. When illiterate patients are assessed, the it is recommended to employ a cut-off of 4 or more.