[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)

[Clinical utility of the 64-card version of the Wisconsin Card Sorting Test in patients with traumatic brain injury]. / Utilidad clinica de la versión de 64 cartas del test de clasificación de cartas de Wisconsin en pacientes que han sufrido un traumatismo craneoencefálico.

AIMS: To analyze the validity of the single deck 64-card Wisconsin Card Sorting Test (WCST-64) compared to the standard version (WCST-128), and to study the sensibility of both versions to identify changes over time in patients with traumatic brain injury (TBI). PATIENTS AND METHODS: The WCST was administered twice across a 6-month period to a sample of 50 patients with TBI. Pearson correlation coefficients were calculated to examine bivariate associations between WCST-128 scores and the corresponding WCST-64 scores at inclusion and at follow-up. Agreement in classification of impairment (z = -1) or normal performance was calculated for the two tests (kappa). Significant change over time was also analyzed for both versions of the test (paired-samples t test). RESULTS: The results revealed positive and significant correlations between both measures as well as a significant agreement in the classification of patients as having deficits or not. Moreover, the WCST-128 and the WCST-64 showed similar ability to identify changes over time. CONCLUSIONS: Our findings showed strong associations between scores derived from the two test and support the comparability of both versions when analyzing cross-sectional or longitudinal data. The findings support the use of the WCST-64 in evaluations of executive deficits of patients with moderate and severe TBI.

[When do patients with traumatic brain injury lose verbal information? Implications for cognitive rehabilitation]. / Cuándo pierden la información verbal los pacientes con daño cerebral postraumático? Implicaciones para la rehabilitación cognitiva.

AIM: Longitudinal study of verbal learning and memory processes after traumatic brain injury (TBI). PATIENTS AND METHODS: Twenty-six patients who had sustained a moderate-severe TBI were assessed with a Spanish version of the California Verbal Learning Test at the time of admission and 6-months after inclusion in a multidisciplinary rehabilitation program that comprised rehabilitation strategies for memory impairments. Global memory indexes were determined, including retroactive interference, proactive interference and recall indexes controlled for level of verbal acquisition. Memory change over time was correlated to demographic and clinical relevant variables, including the level of patients' self-awareness. RESULTS: More than 75% of our patients presented learning, immediate memory and delayed memory deficits at baseline, with an important effect of retroactive interference (69%). At 6-month follow-up, 34.6% showed learning difficulties, 46.2% immediate memory deficits, and 53% delayed memory problems, with 34.6% of the patients showing retroactive interference. Chronicity, level of self-awareness and premorbid intelligence correlated to the degree of memory change over time. CONCLUSIONS: Prominent verbal memory problems developed, not only during the first months after TBI but also over time are mostly due to impaired consolidation related to an intense retroactive interference. These data should be considered when developing memory rehabilitation strategies.

¿Cuándo pierden la información verbal los pacientes con daño cerebral postraumático? Implicaciones para la rehabilitación cognitiva / When do patients with traumatic brain injury lose verbal information? Implications for cognitive rehabilitation

Estudio longitudinal sobre los procesos de aprendizaje y memoria verbal tras un traumatismo craneoencefálico(TCE). Pacientes y métodos. Se evaluaron 26 pacientes que habían sufrido un TCE con el test de aprendizaje verbal complutense de forma subaguda (1-5 meses después del TCE) y tras seis meses de rehabilitación multidisciplinar. Se determinaronlos coeficientes globales de la escala, incluyendo interferencia retro y proactiva y los índices de evocación controlados según el grado de aprendizaje previo. Se determinaron los índices de cambio a lo largo del proceso de seguimiento (puntuaciónglobal final de cada variable menos puntuación inicial) y se correlacionaron (Spearman) con las variables demográficas y clínicas con reconocido valor pronóstico, incluyendo el grado de conciencia de enfermedad. Resultados. Más de las tres cuartas partes de nuestros pacientes presentaban alteraciones de aprendizaje, de memoria inmediata y de memoria tardía,con un importante efecto de interferencia retroactiva en 18 (69%) pacientes. A los seis meses, un 34,6% presentaba alteraciones de aprendizaje, un 46,2% de memoria inmediata, un 53% de memoria tardía, y el efecto interferencial se mantenía en un 34,6%. La cronicidad, el grado de conciencia de los déficit y la capacidad intelectual premórbida correlacionaron con los índices de cambio. Conclusiones. La mayoría de los problemas de evocación que aparecen tanto de forma subaguda como crónica tras un TCE se debe a problemas de consolidación en relación con un potente efecto de interferencia retroactiva. Estos datos deben considerarse a la hora de diseñar estrategias de intervención terapéutica, dado su beneficio

Longitudinal study of verbal learning and memory processes after traumatic brain injury (TBI). Patients and methods. Twenty-six patients who had sustained a moderate-severe TBI were assessed with a Spanish version of the California Verbal Learning Test at the time of admission and 6-months after inclusion in a multidisciplinary rehabilitation program thatcomprised rehabilitation strategies for memory impairments. Global memory indexes were determined, including retroactive interference, proactive interference and recall indexes controlled for level of verbal acquisition. Memory change over timewas correlated to demographic and clinical relevant variables, including the level of patients’ self-awareness. Results. More than 75% of our patients presented learning, immediate memory and delayed memory deficits at baseline, with an importanteffect of retroactive interference (69%). At 6-month follow-up, 34.6% showed learning difficulties, 46.2% immediate memory deficits, and 53% delayed memory problems, with 34.6% of the patients showing retroactive interference. Chronicity, level ofself-awareness and premorbid intelligence correlated to the degree of memory change over time. Conclusions. Prominent verbal memory problems developed, not only during the first months after TBI but also over time are mostly due to impaired consolidation related to an intense retroactive interference. These data should be considered when developing memory rehabilitation strategies

[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