Cognitive outcomes following functional neurosurgery in refractory OCD patients: a systematic review.

Neurosurgery is a therapeutic option for patients with refractory obsessive-compulsive disorder who do not respond to previous treatments. Although its efficacy in reducing clinical symptomatology has been proven, few studies have analyzed its effects at the cognitive level. The aim of this systematic review was to describe the cognitive outcomes of functional neurosurgery in patients that went through capsulotomies or cingulotomies. PubMed, Medline, Scopus, PsycInfo, PsyArticles, and Web of Knowledge were searched for studies reporting cognitive outcomes in refractory obsessive-compulsive patients after capsulotomies and cingulotomies. The risk of bias was assessed with the Assessment Tool for Before-After (Pre-Post) Studies With No Control Group tool; 13 studies met inclusion criteria, including 205 refractory obsessive-compulsive disorder patients for both surgical procedures. Results showed a substantial number of studies that did report significant cognitive improvement after surgery, being this improvement specially related to memory and executive functions. The second-most frequent finding is the maintenance of cognitive performance (nor improvement or worsening). From a neuropsychological point of view, this outcome might be considered a success, given that it is accompanied by amelioration of obsessive-compulsive symptoms. Subtle cognitive adverse effects have also been reported. Neurosurgery procedures appear to be safe from a cognitive point of view. Methodological issues must be improved to draw clearer conclusions, but capsulotomies and cingulotomies constitute an effective alternative treatment for refractory obsessive-compulsive disorder patients.

Apathetic symptoms and white matter integrity after traumatic brain injury.

PRIMARY OBJECTIVE: The aim of the study was twofold. First, to study the relationship among apathy in the long term, initial clinical measures, and standard outcome scores after traumatic brain injury (TBI). Second, to describe white matter integrity correlates of apathy symptoms. RESEARCH DESIGN: Correlational study. Methods and Procedures: Correlation and Bayesian networks analyses were performed in a sample of 40 patients with moderate to severe TBI in order to identify the relationship among clinical variables, functionality, and apathy. A diffusion tensor imaging study was developed in 25 participants to describe correlations between fractional anisotropy (FA) measures and apathetic symptoms. MAIN OUTCOMES AND RESULTS: Correlation analysis revealed associations between pairs of variables as apathy in the long term and functional score at discharge from hospital. Bayesian network illustrated the relevant role of axonal injury mediating the relationship between apathy and initial clinical variables. FA in the superior longitudinal fasciculus, the inferior longitudinal fasciculus, and the internal capsule were negatively correlated with apathy measures. Widespread brain areas showed positive correlations between FA and apathy. CONCLUSIONS: These results highlight the relevance of white matter integrity measures in initial assessment after TBI and its relationship with apathetic manifestations in the chronic phase.

Neurorehabilitation in the times of Covid-19: insights from the Spanish Neurorehabilitation Society (SENR).

The entire world is experiencing an unprecedented global health crisis and Spain has been one of the most heavily affected countries within Europe. Unexpected rapid changes and reorganization of medical services that occurred during the pandemic lead to an impact in the practice of neurorehabilitation. The idiosyncrasies typical of neurorehabilitation management, specially in acute facilities, that makes it susceptible as a vector of dissemination of Covid but also because of the need of finding new wards and intensive care units for Covid patients, the interventions in neurorehabilitation has suffered enormous changes. There is a need for rethinking the future to treat a new wave of patients with neurorehabilitation necessities such as those recovering from Covid 19 with neurological sequelae but also of those neurorehab patients who were unable to access the health system during the locke down period. This article is intended to invite to reflect on and discuss the redesign of our current neurorehabilitation plans after the experience on the Covid 19 pandemic.

Futuro de la neurorrehabilitación tras la pandemia por el SARS-CoV-2 / The future of neurorehabilitation after the SARS-CoV-2 pandemic

No disponible

Evolution of cognitive impairment after a traumatic brain injury: is there any improvement after controlling the practice effect? / Evolución de las alteraciones cognitivas tras un traumatismo craneoencefálico: ¿hay mejoría tras controlar el efecto de la práctica?

INTRODUCTION: The importance of knowing the pattern of evolution of cognitive deficits in the first months after a traumatic brain injury (TBI) has encouraged the development of numerous longitudinal studies. However, the results of most of them should be taken with caution due to the lack of adequate control of practice effects that can lead to overestimating the genuine recovery of cognitive processes. AIM: To describe the cognitive changes between the acute and subacute phases of the TBI controlling the effect of the practice. PATIENTS AND METHODS: Twenty-two patients were assessed in two different time points after TBI (immediately and after six months) using the following tests: Trail Making Test (A, B, B/A, B-A), Stroop Test (W, C, CW, interference), Digit Symbol-Coding, Symbol Search, Digits Forward and Backward, Verbal Fluency and Short-term Memory. To control for the practice effects, a transformation of the scores was performed applying the procedure proposed by Calamia et al. RESULTS. Before controlling the practice effects, the scores of all tests improved (p > 0.001). However, afterward, the improvement remained only in the Trail Making Test-B, B/A and B-A, Digit Symbol-Coding, Symbol Search, Stroop CW and Digits Backward. CONCLUSIONS: The lack of control of practice effects in longitudinal studies can generate misleading interpretations about the evolution of cognitive deficits. The pattern of recovery after a TBI varies depending on the cognitive process.

TITLE: Evolución de las alteraciones cognitivas tras un traumatismo craneoencefálico: ¿hay mejoría tras controlar el efecto de la práctica?Introducción. La importancia de conocer el patrón de evolución de los déficits cognitivos en los primeros meses tras un traumatismo craneoencefálico (TCE) ha fomentado el desarrollo de numerosos estudios longitudinales. Sin embargo, los resultados de la mayoría de ellos deberían tomarse con cautela debido a la falta de un control adecuado del efecto de la práctica, que puede llevar a sobreestimar la recuperación genuina de los procesos cognitivos. Objetivo. Describir los cambios cognitivos entre las fases aguda y subaguda del TCE controlando el efecto de la práctica. Pacientes y métodos. Veintidós pacientes realizaron dos evaluaciones neuropsicológicas tras el TCE (inmediata y tras seis meses) mediante los siguientes tests: Trail Making Test (A, B, B/A y B-A), test de Stroop (P, C, PC e interferencia), clave de números, búsqueda de símbolos, dígitos directos e inversos, fluidez verbal y memoria inmediata. Para controlar el efecto de la práctica se realizó una transformación de las puntuaciones aplicando el procedimiento propuesto por Calamia et al. Resultados. Antes de controlar el efecto de la práctica, se evidenció una mejoría en las puntuaciones de todos los tests (p > 0,001). Sin embargo, tras él, la mejoría permaneció sólo en el Trail Making Test-B, B/A y B-A, la clave de números, la búsqueda de símbolos, el test de Stroop PC y los dígitos inversos. Conclusiones. La falta de control del efecto de la práctica en estudios longitudinales puede generar interpretaciones erróneas sobre el perfil de evolución de los déficits cognitivos. El patrón de recuperación tras un TCE varía en función del proceso cognitivo.

El uso de los teléfonos móviles en la rehabilitación de las lesiones cerebrales / No disponible

Las tecnologías de la información y comunicación (TIC) han experimentado un importante desarrollo en los últimos años. El uso de la telefonía móvil se ha generalizado a toda la población y ofrecen la posibilidad de que sea incorporada como una herramienta más en el ámbito de la rehabilitación de pacientes con lesiones cerebrales. Sus posibilidades abarcan desde la evaluación en contextos reales y cercanos al paciente, la utilización como herramienta de estimulación y restauración de los procesos cognitivos, a su uso como ayuda externa de carácter compensatorio. Es ésta última función la que resulta de más interés para la rehabilitación y que, previsiblemente, mostrará un mayor desarrollo en el ámbito de la rehabilitación. Si bien, para el éxito pleno de la implantación se hace necesario un cambio de actitud en los profesionales y que sea considerada de utilidad para el éxito de la rehabilitación, algo que ya está mostrando la literatura científica a lo largo de los últimos años

Information and communication technologies (ICT) have undergone a significant development in recent years. The use of mobile telephony has widely spread to the entire population and offers the possibility of incorporating it as a tool in the field of rehabilitation of patients with brain lesions. Its possibilities range from the assessment of patients in real contexts, its use as a tool of stimulation and restoration of the cognitive processes, or even its use as compensatory external aid. This latter function is of great interest for the rehabilitation and it will probably show a greater development in the rehabilitation area. However, a change of attitude is necessary among the therapists for the full success of the implantation of this technology. They must consider the usefulness of ICT for the success of the rehabilitation, something that has been already been shown by the scientific literature in recent years

Achromatic synesthesias - a functional magnetic resonance imaging study.

Grapheme-color synesthetes experience consistent, automatic and idiosyncratic colors associated with specific letters and numbers. Frequently, these specific associations exhibit achromatic synesthetic qualities (e.g. white, black or gray). In this study, we have investigated for the first time the neural basis of achromatic synesthesias, their relationship to chromatic synesthesias and the achromatic congruency effect in order to understand not only synesthetic color but also other components of the synesthetic experience. To achieve this aim, functional magnetic resonance imaging experiments were performed in a group of associator grapheme-color synesthetes and matched controls who were stimulated with real chromatic and achromatic stimuli (Mondrians), and with letters and numbers that elicited different types of grapheme-color synesthesias (i.e. chromatic and achromatic inducers which elicited chromatic but also achromatic synesthesias, as well as congruent and incongruent ones). The information derived from the analysis of Mondrians and chromatic/achromatic synesthesias suggests that real and synesthetic colors/achromaticity do not fully share neural mechanisms. The whole-brain analysis of BOLD signals in response to the complete set of synesthetic inducers revealed that the functional peculiarities of the synesthetic brain are distributed, and reflect different components of the synesthetic experience: a perceptual component, an (attentional) feature binding component, and an emotional component. Additionally, the inclusion of achromatic experiences has provided new evidence in favor of the emotional binding theory, a line of interpretation which constitutes a bridge between grapheme-color synesthesia and other developmental modalities of the phenomenon.

[Processing speed in relapsing-remitting multiple sclerosis: the role played by the depressive symptoms]. / Velocidad de procesamiento en la esclerosis multiple remitente recurrente: el papel de los sintomas depresivos.

INTRODUCTION: Reduced speed of information processing seems to characterize neuropsychological performance in multiple sclerosis (MS) patients. However, the impact in speed of information processing of depressive symptoms, that are highly prevalent in this population, has not been precisely defined yet due to the presence of some methodological limitations in most preceding studies. SUBJECTS AND METHODS: 42 MS remittent recurrent patients, 20 with depressive symptoms (BDI > 13), and 22 without, were compared to 24 healthy controls in neuropsychological tasks of speed of processing (SDMT, Stroop, TMT y PASAT-BNB). RESULTS: MS patients without depressive symptoms performed significantly worse than healthy controls the Stroop (W, C and WC), and the PASAT-BNB (execution time) tests. MS patients with depressive symptoms performed significantly worse than healthy controls the Stroop (W, C and WC), SDMT, TMT (A, B and B-A), and the PASAT-BNB (execution time and errors) tests. MS patients with depressive symptoms performed significantly worse than MS patients without depressive symptoms the SDMT, TMT (A, B and B-A), and the PASAT-BNB (execution time) tests. CONCLUSIONS: MS impact was not generalized in neuropsychological performance of patients. Depressive symptoms seem to play and important role determining the speed deficit. While MS reduced speed of information processing, depressive symptoms were associated to specific cognitive deficit different from speed ones.

Construct validity of the Trail Making Test: role of task-switching, working memory, inhibition/interference control, and visuomotor abilities.

The aim of this study was to clarify which cognitive mechanisms underlie Trail Making Test (TMT) direct and derived scores. A comprehensive review of the literature on the topic was carried out to clarify which cognitive factors had been related to TMT performance. Following the review, we explored the relative contribution from working memory, inhibition/interference control, task-switching ability, and visuomotor speed to TMT performance. Forty-one healthy old subjects participated in the study and performed a battery of neuropsychological tests including the TMT, the Digit Symbol subtest [Wechsler Adult Intelligence Scale (Third Version) (WAIS-III)], a Finger Tapping Test, the Digits Forward and Backward subtests (WAIS-III), Stroop Test, and a task-switching paradigm inspired in the Wisconsin Card Sorting Test. Correlation and regression analyses were used in order to clarify the joint and unique contributions from different cognitive factors to the prediction of TMT scores. The results suggest that TMT-A requires mainly visuoperceptual abilities, TMT-B reflects primarily working memory and secondarily task-switching ability, while B-A minimizes visuoperceptual and working memory demands, providing a relatively pure indicator of executive control abilities.

[Functional magnetic resonance and neuropsychology: basic concepts]. / Neuropsicología y resonancia magnética funcional: conceptos generales.

This paper describes the specific tasks of the neuropsychologist in a medical imaging department during the study of the relations between the brain and behavior. The neuropsychologist's role as a member of a multidisciplinary team centers on paradigm design (motor, visual, language, memory, etc.), supervising subjects' (patients' or controls') behavior during functional magnetic resonance acquisition, and interpreting the results. Thus, it is essential for the neuropsychologist to know the characteristics, possibilities, and limitations of the imaging technique as well as aspects directly related to neuropsychology, such as cognitive processes and their components. We also introduce some common concepts in functional magnetic resonance and review some of the paradigms that are most frequently employed in clinical concepts.

Neuropsicología y resonancia magnética funcional: conceptos generales / Functional magnetic resonance and neuropsychology: basic concepts

El presente trabajo presenta las tareas específicas del neuropsicólogo en una Unidad de Imagen médica durante el estudio de las relaciones entre el cerebro y la conducta. Su papel como parte del equipo multidisciplinario se centra en el diseño de paradigmas (motor, visual, lenguaje, memoria, etc.), la supervisión de la conducta de los sujetos (pacientes o controles) durante la realización de los registros de resonancia magnética funcional y la interpretación de los resultados. Todo ello obliga al neuropsicólogo a conocer no sólo aquello que le es propio (los procesos cognitivos y sus componentes), sino también las características, posibilidades y limitaciones de la técnica con la que trabaja. De igual forma se introducen algunos conceptos de uso habitual en resonancia magnética funcional y se revisan algunos de los paradigmas de uso más frecuente en contextos clínicos (AU)

This paper describes the specific tasks of the neuropsychologist in a medical imaging department during the study of the relations between the brain and behavior. The neuropsychologist's role as a member of a multidisciplinary team centers on paradigm design (motor, visual, language, memory, etc.), supervising subjects' (patients' or controls') behavior during functional magnetic resonance acquisition, and interpreting the results. Thus, it is essential for the neuropsychologist to know the characteristics, possibilities, and limitations of the imaging technique as well as aspects directly related to neuropsychology, such as cognitive processes and their components. We also introduce some common concepts in functional magnetic resonance and review some of the paradigms that are most frequently employed in clinical concepts (AU)

Tensor de difusión por Resonancia Magnética y velocidad de procesamiento: estudio de la sustancia blanca en pacientes con traumatismo craneoencefálico / Tensor diffusion by MRI and speed processing of the white matter after brain injuries

Objetivos: Estudiar la relación entre la sustancia blanca cerebral, la lentitud en el procesamiento de información y las alteraciones del control atencional, características tras un TCE grave. Material y métodos: Se obtuvieron imágenes de tensor de difusión por resonancia magnética (DTI) en 15 pacientes con TCE y 15 controles. Todos fueron también evaluados con el Test de Stroop y el Trail Making Test, para estudiar la existencia de correlaciones entre medidas de conducta y neuroimagen. Resultados: El análisis de la conducta reveló una alteración del rendimiento de los pacientes en las puntuaciones influidas por la velocidad de procesamiento, y en el TMT-B/A. El análisis de las imágenes mostró una correlación entre anisotropía y velocidad de procesamiento. En contraste, no se encontraron correlaciones significativas entre el estado axonal y las puntuaciones libres de la velocidad. Conclusiones: Parte de las dificultades de los pacientes con TCE grave en tareas de control atencional se deben a un déficit en la velocidad de procesamiento. Los resultados del análisis DTI permiten afirmar por vez primera que dichas alteraciones están directamente relacionadas con las lesiones de la sustancia blanca cerebral (AU)

Objetives: The present work studies the possible ties among white matter, slowness of information processing and the deficits on attentional control, frequently impaired after TBI. Method: Fractional anisotropy (FA) values were measured in 15 TBI patients and 15 healthy controls. All subjects were also assessed using the Stroop Test and the Trail Making Test. Results: The analyses revealed impairments in the scores influenced by the speed of processing, and in the TMT-B/A. The analyses of the images showed a correlation between anisotropy and speed of processing. On he other hand, there were no significant correlations between the axonal integrity and the scores free of information processing speed. Conclusion: Part of the difficulties showed by TBI patients in attentional control tasks rely on a slowed information processing speed. The results DTI of analyses reveal for the first time that these deficits are directly related to the injuries caused in cerebral white matter (AU)

Resonancia magnética funcional de la corteza visual: estudio de las relaciones entre la intensidad del estímulo y la respuesta BOLD / Functional magnetic resonante imaging of the visual cortex relation between stimulus intensity and bold response

Introducción. La investigación sobre la visión ocupa un lugar central en neurociencia. Nuevas técnicas de neuroimagen, como la resonancia magnética funcional (RMf), permiten aumentar el conocimiento sobre el funcionamiento del sistema visual rápidamente y de forma no invasiva. El presente estudio examina el efecto de pequeños cambios en la intensidad de un estímulo sobre la respuesta de la corteza visual. Objetivos. Analizar la reacción de la corteza visual ante diferentes intensidades de una fuente luminosa, y examinar las posibles diferencias en la respuesta BOLD entre controles y sujetos con fotofobia. Sujetos y métodos. Se realizo una RMf (3 T) a 20 controles y a 20 sujetos con fotofobia, durante la estimulación visual con diferentes intensidades de luz. Se cuantificó la respuesta BOLD, tanto el área como a la intensidad del cambio de señal, en el córtex occipital. Resultados. Se encontró una relación directa entre la intensidad de los estímulos y la respuesta de la corteza occipital, con cambios significativos en el área de activación y con tendencia similar (aunque no significativa) en la intensidad de la respuesta BOLD. Además, la respuesta cortical es más pronunciada en sujetos con fotofobia, sobre todo en intensidades bajas e intermedias. Conclusiones. La RMf se muestra como una técnica válida y robusta para el registro de respuestas consistentes y reproducibles entre distintos sujetos y grupos, tanto para el estudio del funcionamiento normal de la corteza occipital como en casos de respuesta anómala, lo que abre la posibilidad de utilizarla en estudios clínicos

Introduction. Visual system is a high interest topic in neuroscience research. The new neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), allow us to quickly improve our knowledge on the visual system using non-invasive methods. This work examines the effect of small changes in the intensity of a visual stimulus over the BOLD response in the visual cortex. Aims. To perform a detailed analysis of the visual cortex reaction to different intensities of a light source and to verify the ties between the intensity of the visual stimulus and the cortical response. Subjects and methods. Using fMRI (3 T), we registered BOLD response (area and intensity of the signal change) in 20 photophobic patients and 20 controls while viewing different stimulus intensities from a light source. Results. We found a direct relation between stimulus intensity and occipital response. We show that cortical reactivity is higher in patients with photophobia than normal controls, specially for the lower and medium intensities. Conclusions. fMRI is a valid and robust technique to register consistent and reproducible responses in different groups of subjects. It is useful for the study of normal cortex functioning as well as for clinical use

[Functional magnetic resonance imaging of the visual cortex: relation between stimulus intensity and bold response]. / Resonancia magnética funcional de la corteza visual: estudio de las relaciones entre la intensidad del estímulo y la respuesta BOLD.

INTRODUCTION: Visual system is a high interest topic in neuroscience research. The new neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), allow us to quickly improve our knowledge on the visual system using non-invasive methods. This work examines the effect of small changes in the intensity of a visual stimulus over the BOLD response in the visual cortex. AIMS: To perform a detailed analysis of the visual cortex reaction to different intensities of a light source and to verify the ties between the intensity of the visual stimulus and the cortical response. SUBJECTS AND METHODS: Using fMRI (3 T), we registered BOLD response (area and intensity of the signal change) in 20 photophobic patients and 20 controls while viewing different stimulus intensities from a light source. RESULTS: We found a direct relation between stimulus intensity and occipital response. We show that cortical reactivity is higher in patients with photophobia than normal controls, specially for the lower and medium intensities. CONCLUSIONS: fMRI is a valid and robust technique to register consistent and reproducible responses in different groups of subjects. It is useful for the study of normal cortex functioning as well as for clinical use.

Trail Making Test in traumatic brain injury, schizophrenia, and normal ageing: sample comparisons and normative data.

The Trail Making Test (TMT) has been a useful assessment tool to investigate executive function. Several studies have recently improved the existing TMT norms by mean of large samples of healthy individuals stratified by a number of demographic variables from different populations. In contrast, criticisms have been raised about the utility of norms from healthy samples to detect changes across time in clinical samples where TMT performance used to be altered. In addition, few studies have compared groups of patients with deficits in TMT performance, making it difficult to decide whether a single set of norms is sufficient to assess different clinical populations. We provide normative data from three large samples of patients with traumatic brain injury (TBI) (n=90), schizophrenia spectrum disorders (n=127), and healthy Spanish speakers (n=223). Differences between healthy participants and patients in all TMT direct (TMT-A, TMT-B) and derived (B-A, B:A, B-A/A) scores were found. TMT performance was poorer in TBI patients than in schizophrenia patients except for the B:A and B-A/A scores, suggesting a similar underlying executive deficit. Normal ageing impaired both direct and derived TMT indices, as revealed by lower scores in the healthy elderly group (55-80 years old) as compared with young (16-24) and middle-aged (25-54) healthy participants. Three different sets of norms stratified by age, education, or both are presented for clinical use. Recommendations on TMT scores are made for future research.

[Attentional impairment after traumatic brain injury: assessment and rehabilitation]. / Alteraciones de la atención tras daño cerebral traumático: evaluación y rehabilitación.

INTRODUCTION: Attention disorders are a major problem after traumatic brain injury underlying deficits in other cognitive functions and in everyday activities, hindering the rehabilitation process and the possibility of return to work. Functional neuroimaging and neuropsychological assessment have depicted theoretical models considering attention as a complex and non-unitary process. DEVELOPMENT: Although there are conceptual difficulties, it seems possible to establish a theoretical background to better define attentional impairments and to guide the rehabilitation process. The aim of the present study is to review some of the most important pieces involved in the assessment and rehabilitation of attentional impairments. We also propose an appropriate model for the design of individualized rehabilitation programs. Lastly, different approaches for the rehabilitation are reviewed. CONCLUSIONS: Neuropsychological assessment should provide valuable strategies to better design the cognitive rehabilitation programs. It is necessary to establish a link between basic and applied neuropsychology, in order to optimize the treatments for traumatic brain injury patients. It is also emphasized that well-defined cognitive targets and skills are required, given that an unspecific stimulation of cognitive processes (pseudorehabilitation) has been shown to be unsuccessful.

Alteraciones de la atención tras daño cerebral traumático: evaluación y rehabilitación / Attentional impairment after traumatic brain injury: assessment and rehabilitation

Introducción. Las alteraciones de la atención forman parte de los principales problemas que surgen tras un traumatismo craneoencefálico. Éstas pueden influir de forma directa en el funcionamiento de otros procesos cognitivos y en actividades de la vida diaria, y dificultar así el progreso de la rehabilitación y el retorno al trabajo. La evaluación neuropsicológica y la neuroimagen funcional están permitiendo el desarrollo de modelos teóricos que consideran la atención como un proceso complejo y no unitario. Desarrollo. A pesar de la dificultad conceptual, es posible establecer un marco teórico que permita delimitar las alteraciones de los pacientes y guiar el proceso de rehabilitación. El presente trabajo trata de recoger algunos de los aspectos básicos involucrados tanto en la evaluación como en la rehabilitación de las dificultades atencionales, y proponer un modelo que permite una aproximación a la elaboración de programas de evaluación y rehabilitación individualizados. Por último, se revisan distintos abordajes en la rehabilitación de los problemas de atención. Conclusión. La evaluación debe proporcionar bases explicativas y estrategias de utilidad para el desarrollo de programas de rehabilitación cognitiva. Es necesario establecer una relación entre una neuropsicología más orientada a proponer y verificar modelos cognitivos, y aquella dedicada a la aplicación de estos modelos en los programas de rehabilitación. Se pone de manifiesto la necesidad de programas dirigidos al entrenamiento de habilidades específicas, ya que una estimulación inespecífica y no dirigida (pseudorehabilitación) se ha mostrado inefectiva

Introduction. Attention disorders are a major problem after traumatic brain injury underlying deficits in other cognitive functions and in everyday activities, hindering the rehabilitation process and the possibility of return to work. Functional neuroimaging and neuropsychological assessment have depicted theoretical models considering attention as a complex and non-unitary process. Development. Although there are conceptual difficulties, it seems possible to establish a theoretical background to better define attentional impairments and to guide the rehabilitation process. The aim of the present study is to review some of the most important pieces involved in the assessment and rehabilitation of attentional impairments. We also propose an appropriate model for the design of individualized rehabilitation programs. Lastly, different approaches for the rehabilitation are reviewed. Conclusions. Neuropsychological assessment should provide valuable strategies to better design the cognitive rehabilitation programs. It is necessary to establish a link between basic and applied neuropsychology, in order to optimize the treatments for traumatic brain injury patients. It is also emphasized that well-defined cognitive targets and skills are required, given that an unspecific stimulation of cognitive processes (pseudorehabilitation) has been shown to be unsuccessful

[Plasticity of the central nervous system and treatment strategies for sensory and motor reprogram: comparison between two cases of cerebrovascular disease in the middle cerebral artery territory]. / Plasticidad del sistema nervioso central y estrategias de tratamiento para la reprogramación sensoriomotora: comparación de dos casos de accidente cerebrovascular isquémico en el territorio de la arteria cerebral media.

INTRODUCTION: Injury to the central nervous system causes a series of symptoms, which lead to a process of cerebral plasticity. Proprioceptive and exteroceptive information processing from the outside to the brain, influence the development of neuroplasticity, which contributes to either the recovery or maintenance of sensory-motor alterations after a stroke. CASE REPORTS: Two patients with cerebrovascular accident in the left middle cerebral artery territory, one of them ischemic and the other hemorrhagic, whose sensory and motor therapy applied show big differences. CONCLUSIONS: Treatment strategies for functional rehabilitation following a cerebrovascular accident, must be established in relation to current hypotheses on cerebral neuroplasticity and central nervous system pathways, which shows less damage or better sensory motor response. The assessment of neurological signs and symptoms, can indicate which tracts show more or less damage and which ones show greater response to motor recovery treatment. Nevertheless, functional neuroimaging diagnosis provides us with the data in a more reliable way. Even so, among patients that show similar lesion zones, according to diagnosis of computerized tomography or magnetic resonance imaging, there exists a significant clinical variability among different cases, in which case we confirm, in reference to physical treatment, that there are no patients alike, or identical patients even if they have the same clinical diagnosis of the disease.

Plasticidad del sistema nervioso central y estrategias de tratamiento para la reprogramación sensoriomotora: comparación de dos casos de accidente cerebrovascular isquémico en el territorio de la arteria cerebral media / Plasticity of the central nervous system and treatment strategies for sensory and motor reprogram: comparison between two cases of cerebrovascular disease in the middle cerebral artery territory

Introducción. La lesión en el sistema nervioso central provoca una serie de síntomas que desencadenan todo un proceso de plasticidad cerebral. La información propioceptiva y exteroceptiva procesada desde la periferia hasta el cerebro influye en el desarrollo de la neuroplasticidad, de manera que puede contribuir tanto a la recuperación como al mantenimiento de alteraciones sensitivo motoras posteriores a la lesión. Casos clínicos. Dos pacientes con accidente cerebrovascular en la región de la arteria cerebral media izquierda, uno de tipo hemorrágico y otro de tipo isquémico, cuyo abordaje terapéutico sensitivo motor presenta grandes diferencias. Conclusiones. Las estrategias de tratamiento para la recuperación funcional tras accidente cerebrovascular se han de establecer en relación con las hipótesis actuales en torno ala neuroplasticidad cerebral y las vías del sistema nervioso central que presentan menor afectación o mejor respuesta sensitivo motora. La valoración de los signos y síntomas neurológicos externos puede indicar qué vías presentan mayor afectación y cuáles presentan mayor respuesta al tratamiento en orden a la reprogramación motora. Sin embargo, es el diagnóstico por imagen el queaporta estos datos con mayor fiabilidad. Aun así, entre pacientes que presentan zonas similares de lesión, según diagnóstico portomografía axial computarizada o resonancia magnética, existe una significativa variabilidad clínica entre unos casos y otros, por lo que afirmamos que respecto al tratamiento físico, no hay dos pacientes iguales, incluso bajo el mismo diagnóstico clínico de la enfermedad (AU)

Introduction. Injury to the central nervous system causes a series of symptoms, which lead to a process of cerebralplasticity. Propioceptive and exteroceptive information processing from the outside to the brain, influence the development of neuroplasticity, which contributes to either the recovery or maintenance of sensory-motor alterations after a stroke. Case reports. Two patients with cerebrovascular accident in the left middle cerebral artery territory, one of them ischemic and the other hemorrhagic, whose sensory and motor therapy applied show big differences. Conclusions. Treatment strategies for functional rehabilitation following a cerebrovascular accident, must be established in relation to current hypotheses on cerebral neuroplasticity and central nervous system pathways, which shows less damage or better sensory motor response. The assessment of neurological signs and symptoms, can indicate which tracts show more or less damage and which ones show greater response to motor recovery treatment. Nevertheless, functional neuroimaging diagnosis provides us with the data in a more reliable way. Even so, among patients that show similar lesion zones, according to diagnosis of computerized tomography or magnetic resonance imaging, there exists a significant clinical variability among different cases, in which case we confirm, in reference to physical treatment, that there are no patients a like, or identical patients even if they have the same clinical diagnosis of the disease (AU)