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)

Servicios monográficos de rehabilitación del daño cerebral en el marco sanitario / Specialized brain injury rehabilitation services in the healthcare setting

El presente artículo describe las condiciones que propiciaron el surgimiento de los Servicios de rehabilitación para personas con daño cerebral en España en la década de 1990. Se muestra la evolución epidemiológica de los TCE y de los ictus en los últimos 30 años, con reducción de los primeros e incremento de los segundos. Se repasan las características que definen a los Servicios de rehabilitación hospitalaria: su carácter monográfico o especializado, la composición multidisciplinar de los equipos y la elevada intensidad de los tratamientos. Se reflexiona acerca de los procesos que componen el proceso rehabilitador y de los modos de funcionamiento óptimo de estas Unidades. Por último, se hace un reconocimiento explícito de los espacios asistenciales limítrofes, Unidades de convalecencia y residencias de personas mayores, así como de la conveniencia de estratificar a los pacientes en base a su potencial rehabilitador y a la necesidad de cuidados a largo plazo (AU)

This paper describes the social conditions that allowed the dreation and development of Brain Injury Rehabilitation centers in Spain in the last decade of XXth century. The epidemiological changes of traumatic brain injury and of stroke in the last 30 years has implied a gradual decline of the incidence of the former and an advance of the latter. A review of the defining features of these services is undertaken: specialized or monographic, multidiciplinary teams, high intensity treatment. A reflection on the key processes of the rehabilitation offered and on the optimal functioning of theses Units is tackled. Lastly, boundary services are analysed, that is, alternative services such as Convalecence Units or Psychogeriatric Services that offer some kind of rehabilitation for peaple with stroke. There is a clear need to categorize patients with acquired brain injury according to their potential for rehabilitation and their needs of specialized long term care, in order to allocate them in the adequate treatment programme (AU)

Rehabilitación del daño cerebral y unidades de convalecencia / Brain Injury Rehabilitation and Convalescent Units

Existe un consenso generalizado en cuanto que la atención del daño cerebral requiere la existencia de unidades y equipos especializados en dar una atención integral.La realidad es que existe una escasez de recursos para la atención de pacientes con daño cerebral, especialmente en cuanto a laexistencia de unidades específicas de neurorehabilitación o unidades de rehabilitación intensiva. A pesar de que la Congregación de Hermanas Hospitalarias cuenta con la Red Menni de daño cerebral no es suficientepara atender a todos los pacientes. Un número importante de pacientes son atendidos actualmente en unidades de convalecencia (centros afines de la Red Menni), los cuales no todos cuentan con un equipo multidisciplinar ni con la tecnología ni robótica necesaria. (AU)

There is a general consensus that carefor brain damage requires the existence ofunits and teamns specialized in providingcomprehensive care. The reality is that there is a shortage of resources for the care of patients with brain, especially regarding the existence of specific units of neurorehabilitation or intensive rehabilitation units.Even though the Congregation of SistersHospitallers has the Menni Network of brain damage not it is enough to take care of all the patiens.A significant number of patients they are currently cared for in convalescent units (related centers of the Red Menni), nota ll of which have a multidisciplinary tea mor the technology no robotics necessary. (AU)

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)

Feasibility of six-point Goal Attainment Scale among subacute and chronic stroke patients.

Feasibility of six-point Goal Attainment Scale among stroke patients were examined. Thirty-five subacute and chronic stroke patients with upper limb function problems were included (December 2015-March 2017). Sixty-minute conventional therapy and 30-minute occupational therapy was provided on every consecutive weekday, for 4 weeks. Beside Functional Independence Measure, Action Reach Arm test, Fugl-Meyer upper extremity assessment motor function subtest and six-point Goal Attainment Scale were collected. The content of the previous tests was linked with International Classification of Functioning, Disability and Health domains. Feasibility characteristics were checked according to previous feasibility studies and the following aspects: acceptability, demand, implementation, practicality, integration, and expansion. Data analysis was done in 2018. Participants' global functions were described with the Functional Independence Measure median points were 116.5. All of the outcome measures showed significant improvement at group level (P < 0.001). Most of the goals matched to one or more International Classification of Functioning, Disability and Health domains but were not covered with the Action Reach Arm test or the Fugl-Meyer tests. Association between clinically relevant change of the first Goal Attainment Scale and the other tests was not significant. Six-point Goal Attainment Scale proved to be a feasible outcome measure among subacute and chronic stroke participants. It completed the functional picture of a patient, beside standardized measures. Further studies needed to complete the psychometric properties of six-point Goal Attainment Scale among stroke patients and in other patient groups.

Encefalopatía postanóxica tras episodio de muerte súbita reanimada. Cómo minimizar los daños / Postanoxic encaphalopathy after and episode of resuscitated sudden death. Minimizing sequelae

La muerte súbita en personas jóvenes mientras realizan una actividad física intensa es un proceso patológico muy poco prevalente, pero con una importante carga de pérdida de años de vida en la sociedad y con un fuerte impacto social. Presentamos el caso de un varón de 19 años que sufre una parada cardiaca mientras juega un partido de fútbol, con reanimación prolongada, y que sufre múltiples complicaciones posteriores (fracaso renal agudo, coagulopatía, hemorragia digestiva, colitis isquémica y precisa colocación de DAI y realización de hemicolectomía). El inicio de la rehabilitación precoz de manera intensiva en un centro especializado consiguió minimizar las secuelas, permitiendo mejorar en la Escala Rankin desde 4 a 2, y en el Índice de Barthel de 0 a 95 puntos, permitiendo realizar una vida casi autónoma del paciente

Sudden death in young people while performing intense physical activity has a very low prevalence but a significant burden in terms of loss of years of life in society and a strong social impact. We present the case of a 19-year-old man who had a cardiac arrest while playing a football match, with prolonged resuscitation, and multiple subsequent complications (acute renal failure, coagulopathy, digestive bleeding, ischaemic colitis, and need for implantable cardioverter-defibrillator placement and hemicolectomy). The onset of intensive early rehabilitation in a specialised centre minimised the sequels, improving the Rankin score from 4 to 2 and Barthel index from 0 to 95 points, allowing the patient to lead an almost autonomous life

Secuelas del daño cerebral adquirido, estudio sobre las necesidades terapéuticas / Sequelae of acquired brain damage, study of therapeutic needs

Objetivos: conocer la etiología más común del daño cerebral adquirido, calcular el porcentaje de pacientes que necesitan neurorrehabilitación y examinar la sintomatología relacionada con el área de logopedia, permitiendo justificar la importancia de este profesional en el ámbito de la rehabilitación neurológica. Pacientes y método: en este estudio se realizó un análisis de los pacientes con alteraciones neurológicas ingresados en un hospital de media estancia, entre el 1 de enero de 2011 y el 1 de enero del 2017. Todos los pacientes eran mayores de 18 años, de ambos sexos, con daño cerebral adquirido. La muestra fue obtenida a través del software de gestión asistencial del Centro Hospitalario Benito Menni de Valladolid, seleccionando las unidades dedicadas a la rehabilitación: convalecencia y daño cerebral, leyendo cada historia para conocer las secuelas y la rehabilitación recibida. Resultados: del total de pacientes ingresados en este periodo 480 presentaban alteraciones neurológicas, de los cuales 39 fallecieron antes de recibir rehabilitación por su grave estado, y 10 empeoraron debiendo cesar las terapias. Finalmente, un 89.7% recibieron rehabilitación, presentando trastornos motores relacionados con los miembros superiores e inferiores en un 90.8%, un 39.8% problemas deglutorios y las alteraciones de la comunicación en un 39.6% de la muestra. La etiología del problema neurológico más común, con un 56.5%, fue el ictus isquémico, seguido del hemorrágico en un 16.9% de los casos y de los traumatismos craneoencefálicos en un 15.6%. Conclusión: la etiología más relevante dentro de un centro de media estancia es el ictus isquémico. Las secuelas más significativas son los trastornos motores, seguidos de los problemas deglutorios y de comunicación. El logopeda es un profesional destacado en la rehabilitación del paciente neurológico, debido a los porcentajes y relevancia de los síntomas tratados desde esta área. Es necesario establecer un método de evaluación de los pacientes con daño cerebral, fiable, estandarizado y validado

Objectives: to know the most common etiology of acquired brain damage, calculate the percentage of patients who need neurorehabilitation and examine the symptoms related to the area of speech therapy allowing to justify the importance of this professional in the field of neurological rehabilitation. Patients and method: in this study, an analysis of the patients with neurological alterations admitted to a half-stay hospital was carried out between January 1, 2011 and January 1, 2017. All patients were over 18 years old, of both sexes, with acquired brain damage. The sample was obtained through the care management software of the Centro Hospitalario Benito Menni in Valladolid, selecting the units active in rehabilitation: convalescence and brain damage, reading each story to know the sequelae and the rehabilitation received. Results: of the total number of patients admitted in this period, 480 presented neurological alterations, of which 39 patients died before receiving rehabilitation due to their serious condition, and 10 patients worsened due to the cessation of therapies. Finally, 89.7% received rehabilitation, presenting motor disorders related to the upper and lower limbs in 90.8%, 39.8% swallowing problems and communication alterations in 39.6% of the sample. The etiology of the most common neurological problem with 56.5% was ischemic stroke, followed by hemorrhagic in 16.9% of the cases and traumatic brain injuries in 15.6%. Conclusion: ischemic stroke is the most relevant etiology within a half-stay center. The most significant sequelae are motor disorders, followed by swallowing and communication problems. The speech therapist is a prominent professional in the rehabilitation of the neurological patient, due to the percentages and relevance of the symptoms treated in this area. It is necessary to establish a method of evaluating patients with brain damage, reliable, standardized and validated

Efficacy of a new parent and school-supported intervention after moderate and severe childhood traumatic brain injury. / Eficacia de una nueva intervencion de apoyo a padres y escuelas despues de un traumatismo craneoencefalico moderado o grave.

INTRODUCTION: Traumatic brain injury is a common cause of acquired disability during childhood. Early interventions focusing on parenting practices may prove effective at reducing negative child outcomes. AIM: To determine the efficacy of a new counselling program aimed at parents and schools compared to a control group. PATIENTS AND METHODS: The main study sample was obtained from a paediatric hospital. The final sample consisted of 42 children aged between 6 and 16 years old. RESULTS: Comparing with normative data, pre-post comparisons between groups showed a significant improvement in the parent group with respect to the control group. CONCLUSIONS: The superiority of the parental intervention group over those of the control group was not only statistically significant, but also clinically substantial and meaningful. The results of this study suggest that children with moderate to severe traumatic brain injury can benefit from an intensive supported family treatment.

TITLE: Eficacia de una nueva intervencion de apoyo a padres y escuelas despues de un traumatismo craneoencefalico moderado o grave.Introduccion. El traumatismo craneoencefalico es una causa habitual de discapacidad adquirida durante la infancia. Las intervenciones tempranas que se centran en la participacion de los padres pueden resultar efectivas para reducir las disfunciones del niño. Objetivo. Determinar la eficacia de un nuevo programa de asesoramiento dirigido a padres y escuelas en comparacion con un grupo control. Pacientes y metodos. La muestra principal del estudio se obtuvo de un hospital pediatrico. La muestra final consistio en 42 niños de 6 a 16 años. Resultados. Comparando con los datos normativos, las comparaciones pre y post intragrupos mostraron una mejora significativa en el grupo de intervencion parental con respecto al grupo control. Conclusiones. La superioridad del grupo de intervencion parental sobre el grupo control no solo fue estadisticamente significativa, sino tambien clinicamente sustancial y relevante. Los resultados del estudio sugieren que los niños con traumatismo craneoencefalico moderado o grave pueden beneficiarse de un tratamiento familiar intensivo de apoyo.

Programa de educación para padres sobre estimulación del desarrollo del lenguaje de lactantes prematuros con riesgo de daño cerebral / Parent education programme on stimulation of language development in preterm infants at risk of brain damage

Introducción: La interacción temprana madre-hijo es crítica para el desarrollo adecuado del lactante; sin embargo, la interacción de los padres con los lactantes prematuros presenta una dificultad particular por las circunstancias que acompañan un nacimiento prematuro, como son los factores de riesgo de daño cerebral, y la necesidad de estimulación temprana tanto motora como cognitiva que demandan estos bebés. Se ha observado que los programas educativos tienen efectos positivos en los padres de lactantes prematuros ya que mejoran los resultados de sus hijos en evaluaciones motrices, cognitivas y del lenguaje. Método: En este trabajo se examina el efecto de un programa de educación para padres para estimular el desarrollo de las habilidades comunicativas de los lactantes prematuros. Se examinó cómo cambió la interacción padres-hijo después del programa de intervención. Adicionalmente, se compararon los resultados de las evaluaciones de lenguaje de los niños, hijos de los padres que participaron en el programa de intervención comparados con niños pares, hijos de padres que no participaron en dicho programa. Resultados: El programa contribuyó a cambiar la interacción de los padres con los lactantes y a mejorar los puntajes en las evaluaciones posteriores del lenguaje de sus hijos. Conclusión: Se recomienda la participación de los padres de niños prematuros en programas de educación para padres para estimular el desarrollo del lenguaje de sus hijos

Introduction: Early mother-child interaction is critical for proper infant development; however, the interaction of parents with preterm infants presents a particular difficulty due to the circumstances that accompany premature birth, such as risk factors for brain damage and the early motor and cognitive stimulation that these infants demand. It has been observed that educational programmes have positive effects on the parents of preterm infants as they improve the outcomes of their children in motor, cognitive and language assessments. Method: This paper examines the effect of a parent education programme designed to stimulate the development of the early communicative skills of preterm infants. We examined how the parent-child interaction changed following the intervention programme. In addition, the results of the language evaluations of the children whose parents participated in the intervention programme and those whose parents did not participate were compared. Results: The programme helped to change the interaction of parents with their infants and to improve scores in the children's subsequent language assessments. Conclusion: Parents of premature children are encouraged to participate in parent education programmes to encourage the development of their child's language abilities

[Meta-Cognitive Ability and Brain Damage in Autoimmune Encephalitis: A Case Report]. / Otoimmün Ensefalitte Beyin Hasari ve Üst Bilissel Beceri: Bir Olgu Sunumu.

Autoimmune encephalitis is an important contributor to rapidly progressive cognitive and behavioral decline. The purpose of this work was to evaluate the effects of cognitive rehabilitation in a patient with autoimmune encephalitis. We also wanted to evaluate the effectiveness of rehabilitative treatment by monitoring the cognitive and metacognitive outcomes over a time interval. We reported a case of 22 year-old female patient with autoimmune encephalitis, cognitive behavioral impairments, and severe reduction in metarepresentational capacity. We performed an assessment of personality, neuropsychological, and meta-cognitive functions at the beginning of the rehabilitative training. The last evaluation was performed six months after the discharge from the rehabilitation unit. We applied a combination of remediation, psycho-educational treatment, and psychotherapy to improve the knowledge and the empathy of the patient, to promote the selfcontrol strategies, and to prompt better behavioral management. Our findings revealed an improvement in the performance of the individual tests after rehabilitative training.

Feasibility of a home-based computerized cognitive training for pediatric patients with congenital or acquired brain damage: An explorative study.

OBJECTIVES: Pediatric brain damage is associated with various cognitive deficits. Cognitive rehabilitation may prevent and reduce cognitive impairment. In recent years, home-based computerized cognitive training (CCT) has been introduced in clinical practice to increase treatment opportunities for patients (telerehabilitation). However, limited research has been conducted thus far on investigating the effects of remote CCT for the juvenile population in contexts other than English-speaking countries. The aim of the present study was to investigate the feasibility of a home-based CCT in a group of Italian adolescents with brain damage. A commercially available CCT (Lumosity) developed in the English language was used due to the lack of telerehabilitation programs in the Italian language that allow stimulation of multiple cognitive domains and, at the same time, remote automatic collection of data. Thus, this investigation provides information on the possibility of introducing CCT programs available in foreign languages in countries with limited investment in the telerehabilitation field. METHODS: 32 adolescents aged 11-16 with a diagnosis of congenital or acquired (either traumatic or non-traumatic) brain damage participated in the study. They received 40 training sessions (5 days/week for 8 weeks). Before starting the training program, they received face-to-face demonstration of training exercises and written instructions in their mother tongue. The feasibility of both training and study design and procedures was assessed through 9 criteria taken from extant literature. RESULTS: All 9 feasibility criteria were met. 31 out of the 32 participants demonstrated adherence to the training program. 94.2% of training sessions were completed in the recommended timeframe. No significant technical issue was found. CONCLUSIONS: Telerehabilitation seems to be a feasible practice for adolescents with brain damage. A training program developed in a foreign language can be used to counter the unavailability of programs in patients' mother tongue. TRIAL REGISTRATION: The trial is registered with the ISRCTN registry with study ID ISRCTN59250807.

A multifactorial and integrative approach to impulsivity in neuropsychology: insights from the UPPS model of impulsivity.

Risky and excessive behaviors, such as aggressive and compulsive behaviors, are frequently described in patients with brain damage and have dramatic psychosocial consequences. Although there is strong evidence that impulsivity constitutes a key factor at play in these behaviors, the literature about impulsivity in neuropsychology is to date scarce. In addition, examining and understanding these problematic behaviors requires the assumption that impulsivity is a multidimensional construct. Consequently, this article aims at shedding light on frequent risky and excessive behaviors in patients with brain damage by focusing on a unified, comprehensive, and well-validated model, namely, the UPPS model of impulsivity. This model considers impulsivity as a multidimensional construct that includes four facets: urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. Furthermore, we discuss the psychological mechanisms underlying the dimensions of impulsivity, as well as the laboratory tasks designed to assess each mechanism and their neural bases. We then present a scale specifically designed to assess these four dimensions of impulsivity in patients with brain damage and examine the data regarding this multidimensional approach to impulsivity in neuropsychology. This review supports the need to adopt a multifactorial and integrative approach toward impulsive behaviors, and the model presented provides a valuable rationale to disentangle the nature of brain systems and mechanisms underlying impulsive behaviors in patients with brain damage. It may also foster further relevant research in the field of impulsivity and improve assessment and rehabilitation of impulsive behaviors in clinical settings.

Eficacia de la ortesis dinámica del miembro superior en la fase crónica del ictus. Estudio longitudinal / Efficacy of a dynamic orthosis on the upper limbs in the chronic phase of strokes. A longitudinal study

Objetivo. El ictus es la condición médica más importante que origina discapacidad permanente en el adulto. El objetivo es valorar la eficacia de ortesis dinámicas en la rehabilitación del miembro superior en pacientes que han presentado un ictus. Pacientes y métodos. Estudio longitudinal de casos y controles. Se incluyó una muestra de pacientes procedentes de centros de rehabilitación que presentaban hemiparesia secundaria a ictus isquémico o hemorrágico. De forma aleatoria, los pacientes fueron distribuidos en un grupo de estudio, cuyos miembros recibieron una ortesis dinámica en el miembro superior durante seis meses, y un grupo control. Se realizaron valoraciones pre y postratamiento con la ortesis con la Fugl-Meyer Assessment Scale y con la Wolf Motor Function para medir los dominios de las funciones y actividades corporales. Se compararon las diferencias entre pre y postest usando ANCOVA y t de Student. Resultados. Se incluyó a 40 pacientes (65% hombres) que presentaban una hemiparesia crónica secundaria a ictus isquémico (n = 28) o hemorrágico (n = 12), con una edad media de 58,43 ± 8,67 años. Tras el seguimiento de seis meses, se observó una mejoría en ambos grupos en la función motora según ambas escalas. El uso de la ortesis dinámica se asoció a una tendencia hacia la mejoría en la fuerza de la extremidad superior. Conclusiones. La rehabilitación tras el ictus mejora la fuerza y las actividades corporales en el miembro superior. El uso de una ortesis dinámica puede adicionalmente mejorar la fuerza en este miembro, pero se necesitan más estudios para confirmar nuestros resultados (AU)

Aims. Stroke is the most important medical condition leading to permanent disability in adults. The aim of this study is to evaluate the efficacy of dynamic orthoses in the rehabilitation of the upper limbs in patients who have had a stroke. Patients and methods. We conducted a longitudinal case-control study. The sample used in the study consisted of patients from rehabilitation centres who presented hemiparesis secondary to an ischaemic or haemorrhagic stroke. The patients were randomly distributed into a study group, whose members received a dynamic orthosis on an upper limb for a sixmonth period, and a control group. Appraisals were performed pre- and post-treatment with the orthosis with Fugl-Meyer Assessment Scale and with Wolf Motor Function to measure their command over body functions and activities. Differences between pre- and post-test were compared using ANCOVA and Student’s t. Results. The sample included 40 patients (65% males) who presented chronic hemiparesis secondary to ischaemic (n = 28) or haemorrhagic stroke (n = 12), with a mean age of 58.43 ± 8.67 years. After the six-month follow-up, improved motor function was observed in both groups, according to both scales. The use of a dynamic orthosis was associated with a tendency towards improved strength in the upper limb. Conclusions. Rehabilitation following a stroke improves strength and body activities in the upper limb. the use of a dynamic orthosis can further improve the strength in this limb, but additional research is needed to confirm our results (AU)

Efectividad de programas de terapia ocupacional en personas con daño cerebral adquirido en el ámbito domiciliario y ambulatorio: una revisión sistemática / Effectiveness of occupational therapy programmes in the home and ambulatory setting for people with an acquired brain injury: a systematic review

Introducción. Los programas de rehabilitación domiciliaria y ambulatoria son fundamentales en la recuperación funcional en personas con daño cerebral adquirido. El objetivo de esta revisión es comprobar la efectividad de programas de terapia ocupacional domiciliaria y atención primaria, sobre el nivel de independencia de las actividades de la vida diaria, en personas adultas con daño cerebral adquirido. Metodología. Se realizó una búsqueda bibliográfica, en bases de datos especializadas en revisiones sistemáticas (CRD Database) y de estudios originales (Pubmed, Scopus, Web of Science y OTseeker). Se analizaron las siguientes variables: funcionalidad en las actividades de la vida diaria, n.° de días de estancia hospitalaria, intensidad de las sesiones de rehabilitación realizadas, tiempo de espera desde el alta hospitalaria al inicio del proceso de rehabilitación y n.° de reingresos. Resultados. Se seleccionaron una revisión sistemática y cuatro estudios originales. Tres de los cuatro estudios fueron ensayos clínicos aleatorizados, el estudio restante fue un ensayo clínico no controlado. Conclusiones. La evidencia es limitada para afirmar con rotundidad la efectividad de los programas de terapia ocupacional en rehabilitación domiciliaria y ambulatoria, en personas con daño cerebral adquirido. Se produjeron algunas diferencias significativas sobre los niveles de independencia en actividades de la vida diaria, fruto de intervenciones muy heterogéneas entre sí (AU)

Introduction. Home and outpatient rehabilitation programmes are crucial in the functional recovery of people with an acquired brain injury. The objective of this review was to determine the effectiveness of home occupational therapy programmes and primary care in increasing independence for activities of daily living in adults with an acquired brain injury. Methodology. A literature search was conducted in databases specialised in systematic reviews (CRD Database) and in original articles (Pubmed, Scopus, Web of Science and OTseeker). The following variables were analysed: activities of daily living functionality, length hospital stay, the intensity of the rehabilitation sessions carried out, waiting time from hospital discharge to the start of the rehabilitation process, and number of readmissions. Results. A systematic review and four original studies that met the inclusion criteria were retrieved. Three of the four studies were randomised controlled trials and the remaining study was a non-controlled clinical trial. Conclusions. The evidence is too limited to allow definitive conclusions to be drawn on the effectiveness of occupational therapy programmes in the home or ambulatory setting in people with an acquired brain injury. There were some significant differences in levels of independence in activities of daily living, but these were the result of widely heterogeneous interventions (AU)

[Rehabilitation treatment in child and youth patients with acquired brain injury]. / Tratamiento rehabilitador en el paciente infantojuvenil con daño cerebral adquirido.

Brain injury is one of the most frequent causes of death and disability in the child and adolescent. The improvement in patient care in the acute moment and the evolution of health care has meant and increase in the survival of these patients and also of the sequelae. Physical, cognitive-behavioral or organic symptoms are usually. The second is being one of the most frequent and most limiting in these patients. The brain injury affects the patient but involves the whole family because of the disability and the dependence it entails. The team is multidisciplinary and the rehabilitation physician performs the coordination functions. The family should receive assistance from the first day and are an important part in the proper evolution of patients. The treatment must be individualized and adapted for each patient and usually last between 6 and 18 months.

TITLE: Tratamiento rehabilitador en el paciente infantojuvenil con daño cerebral adquirido.El daño cerebral es una de las causas mas frecuentes de muerte y discapacidad en la poblacion infantojuvenil. La mejoria en la atencion a los pacientes en el momento agudo y la evolucion de la asistencia sanitaria han supuesto un aumento de la supervivencia de estos pacientes y tambien de las secuelas. Secuelas fisicas, cognitivo-conductuales u organicas son frecuentes, y las segundas son unas de las mas frecuentes y mas limitantes en estos pacientes. El daño cerebral afecta al paciente, pero involucra a toda la familia por la discapacidad que implica y por la dependencia que conlleva. El equipo es multidisciplinar, y el medico rehabilitador hace las funciones de coordinacion. La familia debe recibir asistencia desde el primer dia y es parte importante en la evolucion adecuada de los pacientes. El tratamiento debe ser individualizado y adaptado para cada paciente, y suele durar entre 6 y 18 meses.

[Infantile acquired brain injury, a personal experience. Demands from the socio-familial point of view]. / Daño cerebral sobrevenido infantil, una experiencia personal. Reclamaciones desde el punto de vista sociofamiliar.

We report on the experience of a family in which the youngest child has acquired brain injury and the struggle undertaken by the family to improve the neurorehabilitation resources in the public health service. The article outlines the main demands, from the socio-familial point of view, as regards the improvement of neurological rehabilitation and the resources needed to deliver it.

TITLE: Daño cerebral sobrevenido infantil, una experiencia personal. Reclamaciones desde el punto de vista sociofamiliar.Se describe la experiencia de una familia en la que el hijo menor tiene daño cerebral sobrevenido y la lucha emprendida por la familia para mejorar los recursos neurorrehabilitadores de la sanidad publica. Se recogen las principales reclamaciones, desde el punto de vista sociofamiliar, en cuanto a la mejora en la atencion neurorrehabilitadora y los recursos necesarios.

[Predictors of cognitive outcome in ventilated early rehabilitation patients]. / Prädiktoren des kognitiven Outcomes beatmeter Frührehabilitationspatienten.

BACKGROUND: After weaning failure, patients who are transferred from intensive care units to early rehabilitation centers (ERC) not only suffer from motor deficits but also from cognitive deficits. It is still uncertain which patient factors have an impact on cognitive outcome at the end of early rehabilitation. OBJECTIVE: Investigation of predictors of cognitive performance for initially ventilated early rehabilitation patients. METHODS: A total of 301 patients (mean age 68.3 ± 11.4 years, 67% male) were consecutively enrolled in an ERC for a prospective observational study between January 2014 and December 2015. To investigate influencing factors on cognitive outcome operationalized by the neuromental index (NMI), we collected sociodemographic data, parameters about the critical illness, comorbidities, weaning and decannulation as well as different functional scores at admission and discharge and carried out multivariate analyses by ANCOVA. RESULTS: Of the patients 248 (82%) were successfully weaned, 155 (52%) decannulated and 75 patients (25%) died of whom 39 (13%) were under palliative treatment. For the survivors (n = 226) we could identify independent predictors of the NMI at discharge from the ERC in the final sex and age-adjusted statistical model: alertness and decannulation were positively associated with the NMI whereas hypoxia, cerebral infarction and traumatic brain injury had a negative impact on cognitive ability. The model justifies 57% of the variance of the NMI (R2 = 0.568) and therefore has a high quality of explanation. CONCLUSION: Because of increased risk of cognitive deficits at discharge of ERC, all patients who suffered from hypoxia, cerebral infarction or traumatic brain injury should be intensively treated by neuropsychologists. Since decannulation is also associated with positive cognitive outcome, a rapid decannulation procedure should also be an important therapeutic target, especially in alert patients.

Medición de resultados en el daño cerebral adquirido en una unidad de neurorrehabilitación. Estudio a largo plazo / Measurement of the outcomes in acquired brain injury in a neurorehabilitation unit. A long-term study

Introducción. Tras un daño cerebral brusco se produce una pérdida de capacidades que afectan a la autonomía de la persona. La recuperación de las secuelas físicas, psíquicas y cognitivas requiere la aplicación de múltiples terapias cuyos resultados precisan una medición objetiva. Nuestro objetivo es analizar la aplicación de instrumentos estandarizados en la determinación de resultados terapéuticos en el daño cerebral adquirido. Pacientes y métodos. Estudio observacional descriptivo retrospectivo de 13 meses de duración. Analizamos datos epidemiológicos y clínicos: tiempo de evolución, grado de independencia (índice de Barthel), presencia de espasticidad y tratamiento con toxina botulínica. Como medida de resultados se usó la Goal Attainment Scaling y la Rehabilitation Complexity Scale, pre y postratamiento. Resultados. Revisamos un total de 45 pacientes, el 60% debido a un ictus. La espasticidad estaba presente en 19 pacientes, y el 42% fue tratado con infiltración de toxina botulínica. Todos realizaron tratamiento con planificación de objetivos; en el 84% de los casos se planificó más de un objetivo terapéutico, y el más prevalente fue la reeducación de la marcha. Con el uso de las escalas se observó que los pacientes con mayor complejidad inicial presentaban una mayor dificultad para lograr los objetivos establecidos, aunque existía un mayor grado de mejora en comparación con su estado previo. Conclusión. La situación de dependencia inicial y el grado de complejidad en las necesidades del paciente con daño cerebral se correlaciona con la situación final tras un programa de tratamiento neurorrehabilitador, de ahí la importancia del uso de escalas como la Goal Attainment Scaling y la Rehabilitation Complexity Scale pre y postratamiento (AU)

Introduction. Following sudden brain damage, there is a loss of capabilities that affects the person’s autonomy. Recovery from the physical, psychic and cognitive sequelae requires the application of multiple therapies, the outcomes of which need to be measured objectively. Our aim is to analyse the application of standardised instruments in determining the therapeutic outcomes in acquired brain injury. Patients and methods. We conducted a retrospective descriptive observational study lasting 13 months. Both epidemiological and clinical data were analysed: elapsed time since onset, degree of independence (Barthel index), presence of spasticity and treatment with botulinum toxin. Outcomes were measured using Goal Attainment Scaling and the Rehabilitation Complexity Scale, pre- and post-treatment. Results. We reviewed a total of 45 patients, 60% of them having suffered a stroke. Spasticity was present in 19 patients, and 42% were treated with botulinum toxin infiltration. All of them underwent goal-setting treatment; in 84% of the cases more than one goal was planned, and the most prevalent was gait re-education. With the use of the scales it was observed that the patients with the greatest initial complexity had more difficulty to achieve the goals that had been set, although there was a higher degree of improvement in comparison to their prior status. Conclusion. The initial situation in terms of dependence and the degree of complexity of the needs of patients with brain damage correlate with the final situation after a programme of neurorehabilitation therapy. This reflects the importance of using scales like Goal Attainment Scaling and the Rehabilitation Complexity Scale, pre- and post-treatment (AU)

Music interventions for acquired brain injury.

BACKGROUND: Acquired brain injury (ABI) can result in impairments in motor function, language, cognition, and sensory processing, and in emotional disturbances, which can severely reduce a survivor's quality of life. Music interventions have been used in rehabilitation to stimulate brain functions involved in movement, cognition, speech, emotions, and sensory perceptions. An update of the systematic review published in 2010 was needed to gauge the efficacy of music interventions in rehabilitation for people with ABI. OBJECTIVES: To assess the effects of music interventions for functional outcomes in people with ABI. We expanded the criteria of our existing review to: 1) examine the efficacy of music interventions in addressing recovery in people with ABI including gait, upper extremity function, communication, mood and emotions, cognitive functioning, social skills, pain, behavioural outcomes, activities of daily living, and adverse events; 2) compare the efficacy of music interventions and standard care with a) standard care alone, b) standard care and placebo treatments, or c) standard care and other therapies; 3) compare the efficacy of different types of music interventions (music therapy delivered by trained music therapists versus music interventions delivered by other professionals). SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 6), MEDLINE (1946 to June 2015), Embase (1980 to June 2015), CINAHL (1982 to June 2015), PsycINFO (1806 to June 2015), LILACS (1982 to January 2016), and AMED (1985 to June 2015). We handsearched music therapy journals and conference proceedings, searched dissertation and specialist music databases, trials and research registers, reference lists, and contacted relevant experts and music therapy associations to identify unpublished research. We imposed no language restriction. We performed the original search in 2009. SELECTION CRITERIA: We included all randomised controlled trials and controlled clinical trials that compared music interventions and standard care with standard care alone or combined with other therapies. We examined studies that included people older than 16 years of age who had ABI of a non-degenerative nature and were participating in treatment programmes offered in hospital, outpatient, or community settings. We included studies in any language, published and unpublished. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias of the included studies. We contacted trial researchers to obtain missing data or for additional information when necessary. Where possible, we presented results for continuous outcomes in meta-analyses using mean differences (MDs) and standardised mean differences (SMDs). We used post-test scores. In cases of significant baseline difference, we used change scores. We conducted a sensitivity analysis to assess the impact of the randomisation method. MAIN RESULTS: We identified 22 new studies for this update. The evidence for this update is based on 29 trials involving 775 participants. A music intervention known as rhythmic auditory stimulation may be beneficial for improving the following gait parameters after stroke. We found a reported increase in gait velocity of 11.34 metres per minute (95% confidence interval (CI) 8.40 to 14.28; 9 trials; 268 participants; P < 0.00001; moderate-quality evidence). Stride length of the affected side may also benefit, with a reported average of 0.12 metres more (95% CI 0.04 to 0.20; 5 trials; 129 participants; P = 0.003; moderate-quality evidence). We found a reported average improvement for general gait of 7.67 units on the Dynamic Gait Index (95% CI 5.67 to 9.67; 2 trials; 48 participants; P < 0.00001). There may also be an improvement in gait cadence, with a reported average increase of 10.77 steps per minute (95% CI 4.36 to 17.18; 7 trials; 223 participants; P = 0.001; low-quality evidence).Music interventions may be beneficial for improving the timing of upper extremity function after stroke as scored by a reduction of 1.08 seconds on the Wolf Motor Function Test (95% CI -1.69 to -0.47; 2 trials; 122 participants; very low-quality evidence).Music interventions may be beneficial for communication outcomes in people with aphasia following stroke. Overall, communication improved by 0.75 standard deviations in the intervention group, a moderate effect (95% CI 0.11 to 1.39; 3 trials; 67 participants; P = 0.02; very low-quality evidence). Naming was reported as improving by 9.79 units on the Aachen Aphasia Test (95% CI 1.37 to 18.21; 2 trials; 35 participants; P = 0.02). Music interventions may have a beneficial effect on speech repetition, reported as an average increase of 8.90 score on the Aachen Aphasia Test (95% CI 3.25 to 14.55; 2 trials; 35 participants; P = 0.002).There may be an improvement in quality of life following stroke using rhythmic auditory stimulation, reported at 0.89 standard deviations improvement on the Stroke Specific Quality of Life Scale, which is considered to be a large effect (95% CI 0.32 to 1.46; 2 trials; 53 participants; P = 0.002; low-quality evidence). We found no strong evidence for effects on memory and attention. Data were insufficient to examine the effect of music interventions on other outcomes.The majority of studies included in this review update presented a high risk of bias, therefore the quality of the evidence is low. AUTHORS' CONCLUSIONS: Music interventions may be beneficial for gait, the timing of upper extremity function, communication outcomes, and quality of life after stroke. These results are encouraging, but more high-quality randomised controlled trials are needed on all outcomes before recommendations can be made for clinical practice.