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1.
BMJ Case Rep ; 13(10)2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33060143

RESUMO

Early case series suggest that about one-third of patients with COVID-19 present with neurological manifestations, including cerebrovascular disease, reported in 2%-6% of hospitalised patients. These are generally older patients with severe infection and comorbidities. Here we discuss the case of a previously fit and well 39-year-old man who presented with fever and respiratory symptoms, evolving in pneumonia with hypoxia but only requiring continuous positive airway pressure. After resolution of the respiratory disease, the patient developed focal neurology and was found to have bilateral occipital, thalamic and cerebellar infarcts. A diagnosis of COVID-19 central nervous system vasculopathy was made. He developed a florid neuropsychiatric syndrome, including paranoia, irritability, aggression and disinhibition, requiring treatment with antipsychotics and transfer to neurorehabilitation. Neuropsychometry revealed a wide range of cognitive deficits. The rapid evolution of the illness was matched by fast resolution of the neuropsychiatric picture with mild residual cognitive impairment.


Assuntos
Sintomas Comportamentais , Infarto Encefálico , Tronco Encefálico , Doenças Cerebelares , Cerebelo , Disfunção Cognitiva , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adulto , Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/fisiopatologia , Sintomas Comportamentais/reabilitação , Betacoronavirus/isolamento & purificação , Infarto Encefálico/diagnóstico , Infarto Encefálico/fisiopatologia , Infarto Encefálico/psicologia , Infarto Encefálico/reabilitação , Tronco Encefálico/irrigação sanguínea , Tronco Encefálico/diagnóstico por imagem , Doenças Cerebelares/fisiopatologia , Doenças Cerebelares/psicologia , Doenças Cerebelares/reabilitação , Doenças Cerebelares/virologia , Cerebelo/irrigação sanguínea , Cerebelo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/reabilitação , Disfunção Cognitiva/virologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Humanos , Masculino , Exame Neurológico/métodos , Testes Neuropsicológicos , Pneumonia Viral/fisiopatologia , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Reabilitação Psiquiátrica/métodos , Resultado do Tratamento
2.
Am J Speech Lang Pathol ; 29(4): 1821-1832, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-32946270

RESUMO

Purpose Severe acute respiratory syndrome coronavirus 2 is the virus resulting in COVID-19 infections in nearly 4.3 million Americans with COVID-19 in the United States as of July 29, 2020, with nearly 150,000 deaths and hundreds of thousands of survivors (https://www.coronavirus.jhu.edu/map.html). This tutorial reviews (a) what has been reported about neurological insults in cases of COVID-19 infection, (b) what is known from similar conditions in other disorders, and (c) how that combined information can inform clinical decision making. Method PubMed and the Cochrane Central Register of Controlled Trials were searched for COVID-19 or other coronavirus infections, cognitive impairment observed following critical care, and disorders for which intermittent or chronic hypoxia is characteristic. These were combined with searches relating to cognition, brain, and communication. All searches were conducted between April 8 and May 23, 2020. Meta-analyses and randomized clinical trials addressing other critical illnesses were also included to extend findings to potential cognitive communication outcomes following COVID-19. Results COVID-19 infection results in a combination of (a) respiratory infection with mechanical ventilation secondary to inadequate oxygenation, (b) inflammatory system reactivity, and (c) increased blood clotting factors. These affect central nervous system function incurring long-term cognitive communication impairment in a proportion of survivors. Diagnostic and intervention approaches for such impairments are discussed. Conclusions The existing literature on cognitive sequela of COVID-19 infection is small to date, but much can be learned from similar viral infections and disorders. Although COVID-19 is novel, the speech-language pathology approaches to evaluation and intervention of other populations of critical care patients are applicable. However, speech-language pathologists have not routinely been involved in these patients' acute care. As such, this is a call to action to speech-language pathologists to address the unprecedented numbers of patients who will need their services early in the disease process and throughout recovery.


Assuntos
Disfunção Cognitiva/etiologia , Transtornos da Comunicação/etiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Patologia da Fala e Linguagem , Betacoronavirus , Disfunção Cognitiva/reabilitação , Transtornos da Comunicação/reabilitação , Delírio/etiologia , Delírio/reabilitação , Humanos , Hipóxia/etiologia , Pandemias , Papel Profissional , Respiração Artificial/efeitos adversos , Trombofilia/etiologia
5.
Clin Rehabil ; 34(6): 773-782, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32380917

RESUMO

OBJECTIVE: The aim of this study is to investigate the effects of combined physical and cognitive training on fall rate and risks of falling in older adults with mild cognitive impairment. DESIGN: The design of this study was an assessor-blinded, randomized controlled trial. SETTING: The setting for this study is the community from Manila, Philippines. SUBJECTS: In total, 92 community-dwelling older persons with mild cognitive impairment (aged 60-83) were randomly allocated to three intervention groups and one waitlist control group. INTERVENTIONS: The physical training, cognitive training, and combined physical and cognitive training intervention programs were delivered for 60 to 90 minutes, one to three times per week for 12 weeks with six-month follow-up. MAIN MEASURES: Participants were assessed at baseline, 12 weeks after baseline, and 36 weeks after baseline for fall incidence, overall fall risk, dynamic balance, walking speed, and lower limb strength. RESULTS: No significant difference was observed across time and groups on fall incidence rate at 12 weeks (P = 0.152) and at 36 weeks (P = 0.954). The groups did not statistically differ in other measures except for a significant improvement in dynamic balance based on Timed Up and Go Test in the combined physical and cognitive training group (9.0 seconds with P = 0.001) and in the cognitive training alone group (8.6 seconds with P = 0.012) compared to waitlist group (11.1 seconds) at 36 weeks. CONCLUSION: There was no significant difference among groups on fall rate and risks of falling post-intervention. Dynamic balance was improved with combined physical and cognitive training and cognitive training alone. Further research with a larger sample size is needed to establish whether or not the interventions are effective.


Assuntos
Acidentes por Quedas/prevenção & controle , Terapia Cognitivo-Comportamental , Disfunção Cognitiva/reabilitação , Terapia por Exercício , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/complicações , Disfunção Cognitiva/psicologia , Exercício Físico/psicologia , Feminino , Humanos , Incidência , Vida Independente , Masculino , Pessoa de Meia-Idade , Filipinas , Equilíbrio Postural , Comportamento de Redução do Risco , Estudos de Tempo e Movimento , Caminhada
6.
Am J Occup Ther ; 74(3): 7403205130p1-7403205130p10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365319

RESUMO

IMPORTANCE: Before introducing strategy training into a cross-cultural (Chinese) context, it is necessary to evaluate its feasibility. OBJECTIVE: To examine the feasibility of applying strategy training to improve participation outcomes of rehabilitation patients in Taiwan and evaluate the potential intervention effects. DESIGN: A single-group, repeated-measures study. SETTING: Rehabilitation outpatient settings. PARTICIPANTS: A convenience sample of adults (N = 20) with a primary diagnosis of acquired brain injury (ABI) and with cognitive impairment received the intervention and were assessed before and after it. INTERVENTION: The participation-focused strategy training intervention, a modified version of the strategy training intervention, was provided to participants in 1-2 sessions weekly for a total of 10-20 intervention sessions. OUTCOMES AND MEASURES: Feasibility indicators, Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), and Canadian Occupational Performance Measure (COPM). RESULTS: Eighteen participants completed 100% of the scheduled intervention sessions. Participants had very good engagement in the intervention sessions with sufficient comprehension. Participants reported moderate to high satisfaction. Positive score changes were observed for the PM-3D4D (d = 0.46-1.25) and COPM scales (d = 1.82 and 2.12). CONCLUSIONS AND RELEVANCE: This study demonstrated the feasibility of delivering participation-focused strategy training in Taiwan to people with cognitive impairment after ABI. The preliminary evidence also showed that participants who received the strategy training intervention had positive changes in participation outcomes and in performance of their self-identified goals. On the basis of this study's findings, a larger clinical trial is warranted to evaluate the efficacy of the strategy training intervention. WHAT THIS ARTICLE ADDS: Participation-focused strategy training is feasible and acceptable for Taiwanese community-dwelling adults with cognitive impairment after ABI. However, because strategy training is quite different from traditional rehabilitation delivered in Taiwan, additional instructions and discussion among the therapist, client, and caregiver may be needed before the intervention is provided.


Assuntos
Lesões Encefálicas/reabilitação , Disfunção Cognitiva/reabilitação , Terapia Ocupacional , Adulto , Estudos de Viabilidade , Humanos , Taiwan
7.
BMC Neurol ; 20(1): 204, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32443981

RESUMO

BACKGROUND: Cognitive dysfunction affects up to 70% of people with progressive MS (PMS). It can exert a deleterious effect on activities of daily living, employment and relationships. Preliminary evidence suggests that performance can improve with cognitive rehabilitation (CR) and aerobic exercise (EX), but existing data are predominantly from people with relapsing-remitting MS without cognitive impairment. There is therefore a need to investigate whether this is also the case in people with progressive forms of the disease who have objectively identified cognitive impairment. It is hypothesized that CR and EX are effective treatments for people with PMS who have cognitive impairment, in particular processing speed (PS) deficits, and that a combination of these two treatments is more effective than each individual treatment given alone. We further hypothesize that improvements in PS will be associated with modifications of functional and/or structural plasticity within specific brain networks/regions involved in PS measured with advanced MRI techniques. METHODS: This study is a multisite, randomized, double-blinded, sham controlled clinical trial of CR and aerobic exercise. Three hundred and sixty subjects from 11 sites will be randomly assigned into one of four groups: CR plus aerobic exercise; CR plus sham exercise; CR sham plus aerobic exercise and CR sham plus sham exercise. Subjects will participate in the assigned treatments for 12 weeks, twice a week. All subjects will have a cognitive and physical assessment at baseline, 12 weeks and 24 weeks. In an embedded sub-study, approximately 30% of subjects will undergo structural and functional MRI to investigate the neural mechanisms underlying the behavioral response. The primary outcome is the Symbol Digit Modalities Test (SDMT) measuring PS. Secondary outcome measures include: indices of verbal and non-verbal memory, depression, walking speed and a dual cognitive-motor task and MRI. DISCUSSION: The study is being undertaken in 6 countries (11 centres) in multiple languages (English, Italian, Danish, Dutch); with testing material validated and standardized in these languages. The rationale for this approach is to obtain a robustly powered sample size and to demonstrate that these two interventions can be given effectively in multiple countries and in different languages. TRIAL REGISTRATION: The trial was registered on September 20th 2018 at www.clinicaltrials.gov having identifier NCT03679468. Registration was performed before recruitment was initiated.


Assuntos
Disfunção Cognitiva , Terapia por Exercício , Exercício Físico/fisiologia , Esclerose Múltipla Crônica Progressiva , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/reabilitação , Humanos , Esclerose Múltipla Crônica Progressiva/complicações , Esclerose Múltipla Crônica Progressiva/reabilitação , Testes Neuropsicológicos
8.
Clin Interv Aging ; 15: 557-566, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32368022

RESUMO

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by airflow limitation in the elderly. Airflow limitation is partially reversible and progressive. COPD not only causes a gradual decline in lung function but also affects the function of other systems throughout the body; it also has adverse effects on the central nervous system that can lead to cognitive impairment, especially in elderly patients. Therefore, understanding the influencing factors of cognitive impairment in elderly patients with COPD and applying early intervention are crucial in improving the quality of life of patients and reducing the burden on their families and society. This article mainly discusses the related factors of cognitive impairment in elderly patients with COPD and expands the possible mechanism of exercise in improving cognitive impairment in patients with COPD to provide a reference for the clinical prevention and treatment of cognitive impairment in elderly patients with COPD.


Assuntos
Disfunção Cognitiva/reabilitação , Terapia por Exercício/métodos , Exercício Físico , Doença Pulmonar Obstrutiva Crônica/reabilitação , Atividades Cotidianas , Idoso , Disfunção Cognitiva/etiologia , Comportamentos Relacionados com a Saúde , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Caminhada
9.
Phys Ther ; 100(7): 1062-1073, 2020 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-32280993

RESUMO

More than 4 million adults survive a stay in the intensive care unit each year, with many experiencing new or worsening physical disability, mental health problems, and/or cognitive impairments, known as post-intensive care syndrome (PICS). Given the prevalence and magnitude of physical impairments after critical illness, many survivors, including those recovering from COVID-19, could benefit from physical therapist services after hospital discharge. However, due to the relatively recent recognition and characterization of PICS, there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community-based settings. This lack of awareness may lead to inappropriate and/or inadequate rehabilitation service provision. While this perspective article provides information relevant to all physical therapists, it is aimed toward those providing rehabilitation services outside of the acute and postacute inpatient settings. This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures, plan of care, and intervention strategies. The importance of providing patient and family education, coordinating community resources including referring to other health care team members, and community-based rehabilitation service options is emphasized. Finally, this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice.


Assuntos
Doença Crônica/reabilitação , Cuidados Críticos , Estado Terminal/reabilitação , Serviços de Assistência Domiciliar , Alta do Paciente , Modalidades de Fisioterapia , Betacoronavirus , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/reabilitação , Infecções por Coronavirus , Humanos , Pandemias , Pneumonia Viral
10.
BMC Geriatr ; 20(1): 84, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122311

RESUMO

BACKGROUND: Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of "at-risk" older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. TRIAL DESIGN AND METHODS: This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients' characteristics. RESULTS: Analyses revealed significant interaction effects for intervention by cognitive status for unplanned re-hospitalization (p = 0.003) and ED presentations (p = 0.021) at 3 months. Within the at-risk subgroup of mild cognitively impaired, the HOME intervention significantly reduced unplanned hospitalizations (p = 0.027), but the effect did not reach significance in ED visits. While the effect of HOME differed according to support received from family for participation in life roles (p = 0.019), the participation observed in HOME patients with no support was not significantly improved. CONCLUSIONS: Findings show that hospitalized older adults with mild cognitive impairment benefit from the HOME intervention, which involves preparation and post-discharge support in the environment, to reduce unplanned re-hospitalizations. Improved discharge outcomes in this at-risk subgroup following an occupational therapist-led intervention may enable best care delivery as patients transition from hospital to home. TRIAL REGISTRATION: The trial was registered before commencement (ACTRN12611000615987).


Assuntos
Assistência ao Convalescente/métodos , Disfunção Cognitiva/reabilitação , Terapia Ocupacional/métodos , Alta do Paciente , Assistência Centrada no Paciente , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Resultado do Tratamento
11.
J Neuroeng Rehabil ; 17(1): 42, 2020 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143674

RESUMO

BACKGROUND: Current evidence for the effectiveness of post-stroke cognitive rehabilitation is weak, possibly due to two reasons. First, patients typically express cognitive deficits in several domains. Therapies focusing on specific cognitive deficits might not address their interrelated neurological nature. Second, co-occurring psychological problems are often neglected or not diagnosed, although post-stroke depression is common and related to cognitive deficits. This pilot trial aims to test a rehabilitation program in virtual reality that trains various cognitive domains in conjunction, by adapting to the patient's disability and while investigating the influence of comorbidities. METHODS: Thirty community-dwelling stroke patients at the chronic stage and suffering from cognitive impairment performed 30 min of daily training for 6 weeks. The experimental group followed, so called, adaptive conjunctive cognitive training (ACCT) using RGS, whereas the control group solved standard cognitive tasks at home for an equivalent amount of time. A comprehensive test battery covering executive function, spatial awareness, attention, and memory as well as independence, depression, and motor impairment was applied at baseline, at 6 weeks and 18-weeks follow-up. RESULTS: At baseline, 75% of our sample had an impairment in more than one cognitive domain. The experimental group showed improvements in attention ([Formula: see text] (2) = 9.57, p < .01), spatial awareness ([Formula: see text] (2) = 11.23, p < .01) and generalized cognitive functioning ([Formula: see text] (2) = 15.5, p < .001). No significant change was seen in the executive function and memory domain. For the control group, no significant change over time was found. Further, they worsened in their depression level after treatment (T = 45, r = .72, p < .01) but returned to baseline at follow-up. The experimental group displayed a lower level of depression than the control group after treatment (Ws = 81.5, z = - 2.76, r = - .60, p < .01) and (Ws = 92, z = - 2.03, r = - .44, p < .05). CONCLUSIONS: ACCT positively influences attention and spatial awareness, as well as depressive mood in chronic stroke patients. TRIAL REGISTRATION: The trial was registered prospectively at ClinicalTrials.gov (NCT02816008) on June 21, 2016.


Assuntos
Disfunção Cognitiva/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Realidade Virtual , Idoso , Disfunção Cognitiva/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Acidente Vascular Cerebral/complicações
12.
Am J Psychiatry ; 177(6): 548-555, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32212856

RESUMO

OBJECTIVE: Age-related cognitive decline, the deterioration in functions such as memory and executive function, is faced by most older adults and affects function and quality of life. No approved treatments exist for age-related cognitive decline. Computerized cognitive training has been shown to provide consistent albeit modest improvements in cognitive function as measured by neuropsychological testing. Vortioxetine, an antidepressant medication, has putative procognitive and proneuroplastic properties and therefore may be able to augment cognitive training. In this placebo-controlled study, the authors tested the cognitive benefits of vortioxetine added to cognitive training for adults age 65 or older with age-related cognitive decline. METHODS: After a 2-week lead-in period of cognitive training, 100 participants were randomly assigned to receive either vortioxetine or placebo in addition to cognitive training for 26 weeks. The primary outcome measure was global cognitive performance, assessed by the NIH Toolbox Cognition Battery Fluid Cognition Composite. The secondary outcome measure was functional cognition, assessed by the UCSD Performance-Based Skills Assessment. All participants received motivational messaging and support from study staff to maximize adherence to the training. RESULTS: Participants who received vortioxetine with cognitive training showed a greater increase in global cognitive performance compared with those who received placebo with cognitive training. This separation was significant at week 12 but not at other assessment time points. Both groups showed improvement in the secondary outcome measure of functional cognition, with no significant difference between groups. CONCLUSIONS: Vortioxetine may be beneficial for age-related cognitive decline when combined with cognitive training. These findings provide new treatment directions for combating cognitive decline in older adults.


Assuntos
Envelhecimento Cognitivo/psicologia , Disfunção Cognitiva/reabilitação , Remediação Cognitiva/métodos , Antagonistas do Receptor 5-HT3 de Serotonina/uso terapêutico , Vortioxetina/uso terapêutico , Idoso , Cognição , Terapia Combinada , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Terapia Assistida por Computador , Resultado do Tratamento
13.
NeuroRehabilitation ; 46(2): 195-204, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32083601

RESUMO

BACKGROUND: A stroke event, sometimes referred to as a cerebrovascular accident (CVA), is a sudden and often traumatic life event that results in life-changing consequences with which affected people must cope. There are nearly 800,000 instances of stroke annually in the U.S. (American Heart Association, 2018). Stroke is the leading cause of disability in adults, and more than one-third of people who survive a stroke will have severe disability in the U.S. (Mayo, 2005). Between 35% and 75% of stroke survivors will have significant cognitive impairment (Tatemichi et al., 1994; Nys et al., 2007). An estimated one-third of people suffer depression after stroke (Hackett et al., 2005), about one-fourth experience significant anxiety (Barker-Collo, 2007), and about one-fifth suffer from insomnia (Leppavuoria et al., 2002). These and other stroke-related psychological issues negatively influence rehabilitation and outcomes through a variety of mechanisms. For example, post-stroke depression has been shown to be related to more negative functional consequences (Kneebone et al., 2000; Matsuzaki et al., 2015). Psychological disturbances may affect rehabilitation outcomes through a reduction in adherence to home exercise programs, reduced energy level, increased fatigue, reduced frustration tolerance, and potentially less motivation and hope about the future. OBJECTIVES: This manuscript aims to identify and describe the role of rehabilitation psychology in treating these common post-stroke complaints and, ultimately, optimizing post-stroke outcomes via two case examples. METHODOLOGY: This manuscript describes two cases of individuals in post-acute rehabilitation who had psychological issues which were negatively affecting outcomes. CONCLUSION: Given the abrupt and significant life-changing nature of stroke, it is often necessary to manage a diverse array of psychological issues that often cannot be simply managed via psychotropic medications. Moreover, an understanding of the patients' emotional adjustment and issues can help them maximize their rehabilitation, recovery, and community integration. For the cases discussed, psychology consultations were central in helping optimize their rehabilitation and functional outcomes.


Assuntos
Reabilitação do Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Adulto , Ansiedade/etiologia , Ansiedade/psicologia , Ansiedade/reabilitação , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/reabilitação , Integração Comunitária/psicologia , Depressão/etiologia , Depressão/psicologia , Depressão/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Estresse Psicológico/reabilitação , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos , Resultado do Tratamento
14.
Medicina (B Aires) ; 80(1): 54-68, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32044742

RESUMO

It is estimated that two thirds of people who have suffered a stroke have sequels that condition their quality of life. The rehabilitation of the stroke is a complex process, which requires the multidisciplinary approach of specialized professionals (doctors, kinesiologists, nurses, occupational therapists, phonoaudiologists, neuropsychologists and nutritionists). Currently, the practices carried out are a consequence of the combination of evidence and consensus, most of them through international stroke rehabilitation guides. The objective of this review is to adjust the international recommendations on stroke rehabilitation to what is applied to daily practice, in order to unify the criteria of the recommendations and to reduce the variability of the practices carried out. This work is a review of the literature on stroke rehabilitation guides developed in the last 10 years. Each section was supervised by different professionals specialized in these areas. We analyze the time and organization necessary to develop rehabilitation, recommendations for motor, cognitive and visual rehabilitation, the management of dysphagia and nutrition, the approach of comorbidities (venous thrombosis, skin ulcers, pain, psychiatric disorders and osteoporosis) and the necessary tasks to favor the return to the activities of daily life.


Assuntos
Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Adulto , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/reabilitação , Humanos , Assistência Centrada no Paciente/métodos , Fatores de Risco
15.
Phys Ther ; 100(3): 523-542, 2020 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-32065236

RESUMO

BACKGROUND: Cancer-related cognitive impairment (CRCI), often called "chemo-brain" or "chemo-fog," is a common side effect among adults with cancer, which can persist well after treatment completion. Accumulating evidence demonstrates exercise can improve cognitive function in healthy older adults and adults with cognitive impairments, suggesting exercise may play a role in managing CRCI. PURPOSE: The purpose was to perform a systematic review of randomized controlled trials (RCTs) to understand the effect of exercise on CRCI. DATA SOURCES: Relevant literature was retrieved from CINAHL, Medline (Ovid), and EMBASE. STUDY SELECTION: Eligible articles were RCTs that prescribed aerobic, resistance, combined aerobic/resistance, or mind-body (eg, yoga or Qigong) exercise during or following cancer treatment and included cognitive function outcome measures. DATA EXTRACTION: Descriptive information and Cohen d effect sizes were directly extracted or calculated for included trials. DATA SYNTHESIS: Twenty-nine trials were included in the final analysis. A statistically significant effect of exercise on self-reported cognitive function, both during and postadjuvant treatment, was reported in 12 trials (41%) (Cohen d range: 0.24-1.14), most commonly using the EORTC QLQ-C30. Ten trials (34%) performed neuropsychological testing to evaluate cognitive function; however, only 3 trials in women with breast cancer reported a significant effect of exercise (Cohen d range: 0.41-1.47). LIMITATIONS: Few RCTs to date have evaluated the effect of exercise on CRCI as a primary outcome. Twenty-six trials (90%) in this review evaluated CRCI as secondary analyses. CONCLUSIONS: Evidence supporting exercise as a strategy to address CRCI is limited. Future research evaluating CRCI as a primary outcome, including self-reported and objective measures, is needed to confirm the possible role of exercise in preventing and managing cognitive impairments in adults with cancer.


Assuntos
Disfunção Cognitiva/reabilitação , Exercício Físico , Neoplasias/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto , Neoplasias da Mama/terapia , Exercícios Respiratórios , Cognição , Disfunção Cognitiva/etiologia , Feminino , Humanos , Masculino , Qigong , Treinamento de Resistência , Autorrelato , Ioga
16.
Artigo em Russo | MEDLINE | ID: mdl-32105275

RESUMO

Sleep-disordered breathing is associated with sleep fragmentation and reduced blood oxygenation due to apnea and hypopnea episodes. Multiple studies indicate that obstructive sleep apnea syndrome (OSAS) can have negative impact on cognitive functioning, primarily executive functions, attention, and episodic memory. The attention is also focused on cognition in patients with neurologic and psychiatric comorbidities. There are different explanatory models, which show the mechanisms of OSAS influence on cognition. However, it is still unclear how the initial severity of the disease and clinical outcomes interrelate, and which factors play role in the compensation of cognitive dysfunction. Better understanding of these issues is crucial for the prevention of cognitive impairment and rehabilitation of cognitive functioning.


Assuntos
Disfunção Cognitiva/complicações , Apneia Obstrutiva do Sono/complicações , Disfunção Cognitiva/prevenção & controle , Disfunção Cognitiva/reabilitação , Função Executiva , Humanos
17.
Cochrane Database Syst Rev ; 2: CD011961, 2020 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-32101639

RESUMO

BACKGROUND: Approximately 60% to 80% of people with Parkinson's disease (PD) experience cognitive impairment that impacts on their quality of life. Cognitive decline is a core feature of the disease and can often present before the onset of motor symptoms. Cognitive training may be a useful non-pharmacological intervention that could help to maintain or improve cognition and quality of life for people with PD dementia (PDD) or PD-related mild cognitive impairment (PD-MCI). OBJECTIVES: To determine whether cognitive training (targeting single or multiple domains) improves cognition in people with PDD and PD-MCI or other clearly defined forms of cognitive impairment in people with PD. SEARCH METHODS: We searched the Cochrane Dementia and Cognitive Improvement Group Trials Register (8 August 2019), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO. We searched reference lists and trial registers, searched relevant reviews in the area and conference proceedings. We also contacted experts for clarifications on data and ongoing trials. SELECTION CRITERIA: We included randomised controlled trials where the participants had PDD or PD-MCI, and where the intervention was intended to train general or specific areas of cognitive function, targeting either a single domain or multiple domains of cognition, and was compared to a control condition. Multicomponent interventions that also included motor or other elements were considered eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles, abstracts, and full-text articles for inclusion in the review. Two review authors also independently undertook extraction of data and assessment of methodological quality. We used GRADE methods to assess the overall quality of the evidence. MAIN RESULTS: Seven studies with a total of 225 participants met the inclusion criteria for this review. All seven studies compared the effects of a cognitive training intervention to a control intervention at the end of treatment periods lasting four to eight weeks. Six studies included people with PD living in the community. These six studies recruited people with single-domain (executive) or multiple-domain mild cognitive impairment in PD. Four of these studies identified participants with MCI using established diagnostic criteria, and two included both people with PD-MCI and people with PD who were not cognitively impaired. One study recruited people with a diagnosis of PD dementia who were living in long-term care settings. The cognitive training intervention in three studies targeted a single cognitive domain, whilst in four studies multiple domains of cognitive function were targeted. The comparison groups either received no intervention or took part in recreational activities (sports, music, arts), speech or language exercises, computerised motor therapy, or motor rehabilitation combined with recreational activity. We found no clear evidence that cognitive training improved global cognition. Although cognitive training was associated with higher scores on global cognition at the end of treatment, the result was imprecise and not statistically significant (6 trials, 178 participants, standardised mean difference (SMD) 0.28, 95% confidence interval (CI) -0.03 to 0.59; low-certainty evidence). There was no evidence of a difference at the end of treatment between cognitive training and control interventions on executive function (5 trials, 112 participants; SMD 0.10, 95% CI -0.28 to 0.48; low-certainty evidence) or visual processing (3 trials, 64 participants; SMD 0.30, 95% CI -0.21 to 0.81; low-certainty evidence). The evidence favoured the cognitive training group on attention (5 trials, 160 participants; SMD 0.36, 95% CI 0.03 to 0.68; low-certainty evidence) and verbal memory (5 trials, 160 participants; SMD 0.37, 95% CI 0.04 to 0.69; low-certainty evidence), but these effects were less certain in sensitivity analyses that excluded a study in which only a minority of the sample were cognitively impaired. There was no evidence of differences between treatment and control groups in activities of daily living (3 trials, 67 participants; SMD 0.03, 95% CI -0.47 to 0.53; low-certainty evidence) or quality of life (5 trials, 147 participants; SMD -0.01, 95% CI -0.35 to 0.33; low-certainty evidence). There was very little information on adverse events. We considered the certainty of the evidence for all outcomes to be low due to risk of bias in the included studies and imprecision of the results. We identified six ongoing trials recruiting participants with PD-MCI, but no ongoing trials of cognitive training for people with PDD. AUTHORS' CONCLUSIONS: This review found no evidence that people with PD-MCI or PDD who receive cognitive training for four to eight weeks experience any important cognitive improvements at the end of training. However, this conclusion was based on a small number of studies with few participants, limitations of study design and execution, and imprecise results. There is a need for more robust, adequately powered studies of cognitive training before conclusions can be drawn about the effectiveness of cognitive training for people with PDD and PD-MCI. Studies should use formal criteria to diagnose cognitive impairments, and there is a particular need for more studies testing the efficacy of cognitive training in people with PDD.


Assuntos
Disfunção Cognitiva/terapia , Demência/terapia , Doença de Parkinson/psicologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/reabilitação , Demência/reabilitação , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise e Desempenho de Tarefas
18.
Fisioterapia (Madr., Ed. impr.) ; 42(1): 33-38, ene.-feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187813

RESUMO

Antecedentes y objetivo: Los programas de ejercicio físico grupales para el adulto mayor son ofrecidos usualmente por los servicios de salud comunitaria, los cuales pueden generar diferentes estímulos en la capacidad física y cognitiva de la población. El objetivo del estudio fue comparar el desempeño en actividades de simple y de doble tarea, equilibrio postural y funciones cognitivas en adultas mayores que participan de diferentes modalidades de ejercicios grupales. Materiales y métodos: Fueron evaluadas 41 adultas mayores pertenecientes a 3 programas de ejercicio (G1=grupo de caminata, G2=grupo de entrenamiento funcional y G3=grupo de danza). Para determinar el nivel de actividad física fue utilizado el International Physical Activity Questionnaire adaptado, para el equilibrio se utilizó el test de apoyo unipodal, para evaluación cognitiva el miniexamen del estado mental y para la evaluación del desempeño en actividades de tarea simple y doble fue contabilizado el número de repeticiones realizando actividades motoras y cognitivas durante 30seg. Para el análisis estadístico, ANOVA de un factor y Kruskal-Wallis fueron utilizadas para la comparación de las variables. El coeficiente de Spearman se utilizó para evaluar la correlación entre las variables. Resultados: Los grupos no fueron diferentes en edad ni índice de masa corporal (IMC), G1 (n=13; edad=62,5±2,9 años; IMC=28,49±6,4kg/m2), G2 (n=13; edad: 64,2±5,9 años; IMC=26,6±4,2kg/m2) y G3 (n=15; edad=66,6±6,05 años; IMC=29,4±8,4kg/m2); p>0,05. El G2 presentó un mayor número de repeticiones de la tarea simple, doble motora y doble motora-cognitiva comparado con el G1 y G3 (p<0,004). Fueron encontradas correlaciones entre la tarea simple, doble motora y doble motora-cognitiva (0,56>r<0,80; p<0,05). Conclusión: Las adultas mayores que practican entrenamiento funcional tienen mejor rendimiento en tareas motoras-cognitivas en comparación con a aquellas que practican danza y caminata


Background and objective: Physical exercise programmes for groups of older people are usually offered by community health services, which can generate different stimulus in the physical and cognitive capacity in this population. The objective of this study was to compare the performance of simple and dual task activities, postural balance and cognitive functions in older adults who took part in different types of group exercises. Materials and methods: A total of 41 older women took part in 3 exercise programmes were evaluated (G1=walking group, G2=functional training group, and G3=dancing group). To determine the level of physical activity the International Physical Activity Questionnaire. Balance was assessed using the unipedal stance test, the cognitive capacity was tested using the mini mental status examination, and the performing of the simple/dual tasks was assessed according to the number of repetitions made during cognitive and motor activities for 30seconds For the statistical analysis, One-way ANOVA and Kruskal-Wallis were used to compare the variables. The Spearman coefficient was used to evaluate the correlation between the variables. Results: There were no differences in age and body mass index (BMI) between the groups, G1 (n=13; age=62.5±2.9 years; BMI=28.49±6.4Kg/m2), G2 (n=13; age: 64.2±5 years; BMI=26.6±4.2Kg/m2), and G3 (n=15; age=66.6±6.05 years; BMI=29.4±8.4Kg/m2), P>.05. G2 showed a better performance in simple, dual motor, and dual motor-cognitive tasks compared to G1 and G3 (P>.004). Correlations were observed between simple, dual motor, and dual motor-cognitive tasks (0.56>r<0.80; P>.05). Conclusion: Older women who practice functional training have better performance in cognitive-motor tasks compared to those who dance and walk


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cognição/fisiologia , Equilíbrio Postural/fisiologia , Exercício Físico/fisiologia , Desempenho Psicomotor/fisiologia , Modalidades de Fisioterapia , Disfunção Cognitiva/reabilitação , Análise de Variância , Índice de Massa Corporal , Envelhecimento/fisiologia , Estudos Transversais , Inquéritos e Questionários , Antropometria , Caminhada , Teste de Caminhada/métodos , Terapia através da Dança
19.
J. negat. no posit. results ; 5(2): 156-166, feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-194006

RESUMO

OBJETIVO: El propósito de este estudio fue conocer si seis semanas de ejercicio físico podrían mejorar la condición física y la composición corporal en personas diagnosticadas de Alzheimer. MÉTODO: Se llevó a cabo un programa de entrenamiento donde 13 individuos (78,5±6,4 años) diagnosticados de Alzheimer, realizaron dos sesiones semanales de entrenamiento, en una de ellas se hizo ejercicio aeróbico en cicloergómetro y en la otra, trabajo de equilibrio, fuerza y coordinación. RESULTADOS: Encontramos cambios significativos en la composición corporal (disminución de masa grasa, y aumento de masa muscular), y en la capacidad funcional, reflejados por la mejora en el test de "sentarse y levantarse de una silla", el test de "levantarse, caminar y volverse a sentar", en la escala de Berg y en las mediciones de la velocidad de la marcha. Las mediciones de dinamometría manual se mantuvieron constantes o mejoraron levemente sin significación suficiente. CONCLUSIÓN: La combinación de entrenamiento aeróbico con ejercicios de fuerza, equilibrio y coordinación, dos veces por semana, durante seis semanas en personas con Alzheimer, podría mejorar la capacidad funcional y la composición corporal. Sin embargo, no parece claro que este protocolo de entrenamiento permita mejorar la fuerza de prensión manual


OBJECTIVE: The purpose of this study was to know if six weeks of physical exercise allowed to improve physical condition and body composition in people diagnosed with Alzheimer's. METHOD: A training program was carried out where 13 individuals (78.5 ± 6.4 years) diagnosed with Alzheimer's disease, performed two weekly training sessions, in one of them aerobic exercise was performed in a cycle ergometer and in the other, they performed balance, strength and coordination exercises. RESULTS: We found significant changes in body composition (decrease in fat mass, and increase in muscle mass), and in functional capacity, reflected by the improvement in the "sitting and getting up from a chair" test, the "getting up," walk and sit down again ", on the Berg scale and on gait speed measurements. The manual dynamometry measurements remained constant or improved slightly without sufficient significance. CONCLUSION: The combination of aerobic training with strength, balance and coordination exercises, twice a week, for six weeks in people with Alzheimer's, could improve functional capacity and body composition. However, it is not clear that this training protocol allows to improve manual grip strength


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/reabilitação , Terapia por Exercício/métodos , Composição Corporal/fisiologia , Desempenho Físico Funcional , Antropometria/métodos , Pesos e Medidas Corporais/estatística & dados numéricos , Dinamômetro de Força Muscular/estatística & dados numéricos , Avaliação de Eficácia-Efetividade de Intervenções , Disfunção Cognitiva/reabilitação , Estudos Controlados Antes e Depois/estatística & dados numéricos , Treinamento de Resistência/métodos , Treinamento de Resistência/métodos
20.
Trials ; 21(1): 19, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907024

RESUMO

BACKGROUND: Alzheimer's disease (AD) is an epidemic with tremendous public health impacts because there are currently no disease-modifying therapeutics. Randomized controlled trials (RCTs) for prevention of AD dementia often use clinical endpoints that take years to manifest (e.g., cognition) or surrogate endpoints that are costly or invasive (e.g., magnetic resonance imaging [MRI]). Blood biomarkers represent a clinically applicable alternative surrogate endpoint for RCTs that would be both cost-effective and minimally invasive, but little is known about their value as surrogate endpoints for treatment responses in the prevention of AD dementia. METHODS: The objective of this study is to investigate blood neuropathological, neurodegenerative, and neurotrophic biomarkers as surrogate endpoints for treatment responses to three interventions in older adults with amnestic mild cognitive impairment (aMCI, a prodromal stage of AD): aerobic exercise, cognitive training, and combined aerobic exercise and cognitive training (ACT). We chose these three sets of biomarkers for their unique mechanistic associations with AD pathology, neurodegeneration and neurogenesis. This study is built on the ACT Trial (1R01AG055469), a single-blinded, multi-site, 2 × 2 factorial phase II RCT that examines the synergistic effects of a 6-month ACT intervention on cognition and MRI biomarkers (AD-signature cortical thickness and hippocampal volume) (n = 128). In this ACT Trial blood biomarkers study, we will enroll 120 ACT Trial participants with aMCI and measure blood biomarkers at baseline and at 3, 6, 12, and 18 months. The goals are to (1) determine the effect of interventions on blood biomarkers over 6 months, (2) evaluate blood biomarkers as surrogate endpoints for predicting cognitive responses to interventions over 18 months, and (3, exploratory) examine blood biomarkers as surrogate endpoints for predicting brain MRI biomarker responses to interventions over 18 months. DISCUSSION: This study aims to identify new blood biomarkers that can track cognitive decline or AD-related brain atrophy among patients with aMCI subjected to a regimen of aerobic exercise and cognitive training. Findings from this study will drive the further use of blood biomarkers in developing effective prevention and treatment strategies for AD dementia. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03313895. Registered on 18 October 2017.


Assuntos
Doença de Alzheimer/reabilitação , Cognição/fisiologia , Disfunção Cognitiva/reabilitação , Demência/prevenção & controle , Terapia por Exercício/métodos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/sangue , Doença de Alzheimer/complicações , Biomarcadores/sangue , Disfunção Cognitiva/sangue , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Demência/sangue , Demência/diagnóstico , Demência/etiologia , Progressão da Doença , Exercício Físico/fisiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
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