Variables predictoras de la duración de la amnesia postraumática tras un traumatismo craneoencefálico / Predictors of the duration of post-traumatic amnesia following traumatic brain injury

Introducción: La duración de la amnesia postraumática (APT) ayuda a estimar el nivel de recuperación tras un traumatismo craneoencefálico (TCE). Sin embargo, apenas se dispone de información sobre qué variables sociodemográficas y clínicas influyen en su duración. Este estudio pretende identificarlas y crear un modelo predictivo que permita estimar el tiempo que un paciente tarda en emerger de la APT. Pacientes y métodos: La muestra estaba formada por 40 pacientes adultos en APT ingresados en un centro neurorrehabilitador. El 89,7% había sufrido un TCE grave; el 10,3% restante, un TCE moderado. Su estado cognitivo se valoró mediante el Galveston Orientation and Amnesia Test (GOAT) –escala que permite determinar en qué momento se puede considerar que un paciente emerge de la APT–. Resultados: Se encontró una ecuación de regresión (F = 8,511; p < 0,001; R2 = 0,415), en la que las siguientes variables (clasificadas por su orden de importancia) explicaron el 41,5% de la variabilidad observada en la duración de la APT: a) GOAT administrado a la llegada al centro neurorrehabilitador; b) años de formación reglada del paciente; y c) días que estuvo en APT antes de ingresar en el centro neurorrehabilitador. La ecuación de regresión derivada fue la siguiente: 104,284 + (–0,708 × GOAT-inicial) + (–4,124 × años formación reglada) + (0,219 × APT-hospital agudos). Conclusiones: El tiempo que un paciente tarda en emerger de la APT está condicionado por la puntuación que obtiene en el primer GOAT administrado al ingresar en el centro neurorrehabilitador, el nivel de estudios, y los días que permanece en APT entre el momento del TCE y el ingreso en el centro neurorrehabilitador.(AU)

Introduction: The duration of post-traumatic amnesia (PTA) helps estimate the level of recovery following traumatic brain injury (TBI). Yet, little information is available about which sociodemographic and clinical variables influence its duration. This study aims to identify them and create a predictive model that makes it possible to estimate the time it takes for a patient to emerge from PTA. Patients and methods: The sample consisted of 40 adult patients with PTA admitted to a neurorehabilitation centre. A total of 89.7% had suffered a severe TBI, whereas the remaining 10.3% had had a moderate TBI. Cognitive status was assessed using the Galveston Orientation and Amnesia Test (GOAT) – a scale for determining at what point a patient can be considered to be emerging from PTA. Results: A regression equation was found (F = 8.511; p < 0.001; R2 = 0.415), in which the following variables (ranked in order of importance) explained 41.5% of the variability observed in the duration of PTA: a) GOAT administered on arrival at the neurorehabilitation centre; b) years of formal education of the patient; and c) days with PTA prior to admission to the neurorehabilitation centre. The equation derived was as follows: 104.284 + (–0.708 × GOAT-initial) + (–4.124 × years formal education) + (0.219 × hospital acute-APT). Conclusions: The time it takes for a patient to emerge from PTA is conditioned by the score obtained in the first GOAT administered on admission to the neurorehabilitation centre, their level of education, and the number of days elapsed with PTA between occurrence of the TBI and admission to the neurorehabilitation centre.(AU)

Intervención no farmacológica en la amnesia postraumática, una revisión sistemática / Non-pharmacological intervention in post-traumatic amnesia, a systematic review

Introducción: Las personas que sobreviven a un traumatismo craneoencefálico pueden presentar un estado transitorio de confusión y perturbación global del funcionamiento cognitivoconductual denominado amnesia postraumática. Objetivo: Describir las características, la calidad metodológica y los principales resultados de los estudios que han analizado el impacto de las intervenciones no farmacológicas en el tratamiento de los síntomas asociados a la amnesia postraumática. Pacientes y métodos: Siguiendo las directrices PRISMA, se realizó una búsqueda bibliográfica de los trabajos publicados en las bases de datos PubMed y PsycInfo durante los últimos 20 años (2000-2020). La calidad metodológica de los artículos se evaluó mediante la escala PEDro. Resultados: Tras aplicar los criterios de inclusión y exclusión, de los 1.036 artículos potencialmente interesantes, ocho cumplieron los criterios de elegibilidad; de estos, cuatro eran ensayos clínicos aleatorizados. Las intervenciones aplicadas se agruparon de la siguiente forma: reentrenamiento estructurado de las actividades de la vida diaria (cuatro estudios), programa de orientación a la realidad (dos estudios), sistema Perceive, Recall, Plan and Perform (un estudio) y aplicación terapéutica de la música (un estudio). Siete de los ocho artículos revisados mostraron resultados positivos o parcialmente positivos. Conclusiones: De acuerdo con los resultados obtenidos, hay indicios de que las intervenciones no farmacológicas tienen efectos positivos en la disminución de la sintomatología cognitivoconductual asociada a la amnesia postraumática.(AU)

Introduction: Survivors of traumatic brain injury may experience a transient state of confusion and global disturbance of cognitive-behavioural functioning called post-traumatic amnesia.Aim. To describe the characteristics, methodological quality and main results of studies that have analysed the impact of non-pharmacological interventions in the treatment of symptoms associated with post-traumatic amnesia. Patients and methods: Following the PRISMA guidelines, a literature search was carried out on papers published in the PubMed and PsycInfo databases over the last 20 years (2000-2020). The methodological quality of the articles was assessed using the PEDro scale. Results: After applying the inclusion and exclusion criteria, of the 1,036 potentially interesting articles, eight met the eligibility criteria, four of which were randomised clinical trials. The interventions applied were grouped as follows: structured retraining of activities of daily living (four studies), reality orientation programme (two studies), Perceive, Recall, Plan and Perform system (one study) and therapeutic application of music (one study). Seven of the eight articles reviewed showed positive or partially positive results. Conclusions: According to the results obtained, there is evidence that non-pharmacological interventions have positive effects on reducing the cognitive-behavioural signs and symptoms associated with post-traumatic amnesia.(AU)

Galveston Orientation and Amnesia Test: validação, aplicabilidade e relação com a Escala de Coma de Glasgow / Galveston Orientation and Amnesia Test: validation, aplicability and the relationship with the Glasgow Coma Scale

A amnésia pós-traumática é um distúrbio freqüente em vítimas com trauma crânio encefálico (TCE) sendo sua duração considerada um forte indicador de gravidade do TCE contuso e um seguro preditor de capacidade funcional. A duração e o término da amnésia pós-traumática têm sido, nos últimos anos, avaliados pelo "Gaveston Orientation and Amnesia Test". Esse instrumento, traduzido e validado no atual estudo, foi renomeado, em língua portuguesa, como Teste de Amnésia e Orientação de Galveston (TAOG). Sua aplicação em 73 vítimas de TCE contuso, juntamente com a avaliação do nível de consciência pela Escala de Coma de Glasgow (ECGI), permitiu verificar as propriedades de medida do TAOG, analisar sua aplicabilidade e identificar as relações entre os resultados obtidos nos dois instrumentos. A confiabilidade verificada pelo Alfa de Cronbach resultou em 0,76, valor suficiente para atestar consistência interna satisfatória do instrumento. Houve evidências de validade convergente e discriminante do TAOG. Com relação à aplicabilidade desse instrumento, o mesmo pôde ser aplicado nos pacientes com ECGI '> ou =' 12, porém o término da amnésia pós-traumática foi verificado nos pacientes com ECGI '> ou =' 14. Quanto às relações entre os resultados obtidos no TAOG e na ECGI, correlação significativa ('r IND. s'=0,65) foi verificada entre essas medidas, no entanto, em 47,2% dos casos o fim da amnésia foi indicada antes ou após pontuação 15 na ECGI. As diferentes formas de relação entre término de amnésia e alteração da consciência observadas oferecem indícios de questões adicionais sobre os déficits cognitivos que ocorrerem após TCE.

Post-traumatic amnesia (PTA) is a very frequent disturbance in victims with traumatic brain injury (TBI), that its length has been regarded a strong index of severity of closed TBI and a safe predictor of outcome. The length and the end of PTA have been evaluated in the last years by the Galveston Orientation and Amnesia Test (GOAT). This scale was translated, validated in the present study, renamed in portuguese as "Teste de Amnésia e Orientação de Galveston" (TAOG). It was applied to 73 patients whith closed TBI, as well as measuring their level of conscienceness, tested by the Glasgow Coma Scale (GCS), which allowed to check the GOAT´s efficiency as a test, its aplicability and to identify the relationship between both tests. The confiabiality was checked by the Cronbach's Alfa, that resulted in 0,75, enough value to garantee sactisfatory internal consistency of the Test. TAOG showed either convergent and discriminant validity. In relation with its aplicability, GOAT could be used in patients with GCS '> or =' 12, but the end of PTA was observed in patients with GCS '> ou =' 14. The relations between the scores presented in GOAT and GCS, a significant correlation ('r IND. s' = 0,65) was verified between these tests, however, in 47,2% the end of the amnesia was showed before or after GCS = 15. The different relationship between the end of amnesia and observed conscience's alteration, offers signs of aditional questions about cognitive deficits that happens after TBI.