Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward / 神经科学通报·英文版

Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an effective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.

A research on improving the food intake assessment method in acquired brain injury patients / 中国实用护理杂志

Objective To apply repetitive saliva swallowing test and standardized swallowing assessment combined with the volume-viscosity swallow test on patients with acquired brain injury, we aim to identify the potential risks of oral intake during the patients′recovery stage, and improve the strategy of aspiration prevention. Methods Totally 142 patients with acquired brain injury were selected as the observation group during November 2016 and November 2017, and 153 patients with acquired brain injury were selected as the control group during October 2015 and October 2016. The control group was assessed by water swallow test, while a combination of the Repetitive Saliva Swallowing Test, the Standardized Swallowing Assessment and Volume-Viscosity Swallow Test was used to assess the observation group till discharging. The detection rate of aspiration risk and the incidence of aspiration pneumonia was compared between the two groups. ResuLts The detection rate of aspiration risk was 36.6% (52/142) in the observation group and 7.8% (12/153) in the control group, the difference was statistically significant (χ2=35.899, P<0.05). The incidence of aspiration pneumonia was 1.4% (2/142) in the observation group and 12.4% (19/153) in the control group, the difference was statistically significant (χ2=13.502, P<0.05). ConcLusions The combined application of the Repetitive Saliva Swallowing Test, the Standardized Swallowing Assessment and the Volume-Viscosity Swallow Test can improve the detection rate of aspiration risk in the acquired- brain- injury patients with suspicious swallowing dysfunction, reduce the incidence of aspiration pneumonia, increase the nursing safety, and improve the health outcomes of neurosurgical patients.

A research on improving the food intake assessment method in acquired brain injury patients / 中国实用护理杂志

Objective@#To apply repetitive saliva swallowing test and standardized swallowing assessment combined with the volume-viscosity swallow test on patients with acquired brain injury, we aim to identify the potential risks of oral intake during the patients′ recovery stage, and improve the strategy of aspiration prevention.@*Methods@#Totally 142 patients with acquired brain injury were selected as the observation group during November 2016 and November 2017, and 153 patients with acquired brain injury were selected as the control group during October 2015 and October 2016. The control group was assessed by water swallow test, while a combination of the Repetitive Saliva Swallowing Test, the Standardized Swallowing Assessment and Volume-Viscosity Swallow Test was used to assess the observation group till discharging. The detection rate of aspiration risk and the incidence of aspiration pneumonia was compared between the two groups.@*Results@#The detection rate of aspiration risk was 36.6% (52/142) in the observation group and 7.8% (12/153) in the control group, the difference was statistically significant (χ2=35.899, P < 0.05). The incidence of aspiration pneumonia was 1.4% (2/142) in the observation group and 12.4% (19/153) in the control group, the difference was statistically significant (χ2=13.502, P < 0.05).@*Conclusions@#The combined application of the Repetitive Saliva Swallowing Test, the Standardized Swallowing Assessment and the Volume-Viscosity Swallow Test can improve the detection rate of aspiration risk in the acquired-brain-injury patients with suspicious swallowing dysfunction, reduce the incidence of aspiration pneumonia, increase the nursing safety, and improve the health outcomes of neurosurgical patients.

Avaliação de estímulos emocionais e reatividade psicofisiológica em pacientes com lesão encefálica adquirida / Evaluation of emotional stimuli and psychophysiological reactivity in patients with acquired brain injury

Introdução: Para o estudo das emoções têm-se utilizado técnicas de autorrelato, nomeadamente, as escalas de valência e de arousal do Self-Assessment Manikin (SAM), que proporcionam uma apreciação cognitiva subjetiva das diferentes dimensões emocionais. No entanto, é legítimo equacionar que esta capacidade de avaliação cognitiva possa estar alterada em pacientes com lesão encefálica adquirida (LEA). Consequentemente, pode haver incongruência na avaliação das suas respostas emocionais. Assim, a avaliação deve incluir outras técnicas complementares, como são as medidas fisiológicas periféricas empiricamente validadas para o estudo das emoções. Métodos: Avaliamos 36 pacientes com LEA em referência a 33 participantes saudáveis. Ambos os grupos observaram imagens agradáveis, desagradáveis e neutras selecionadas do International Affective Picture System (IAPS), que tinham de classificar através das escalas de valência e de arousal do SAM, enquanto eram registadas as suas respostas fisiológicas periféricas: condutância elétrica da pele (CEP) e ritmo cardíaco (RC). Resultados: Nas técnicas de autorrelato, os pacientes com LEA fazem uma avaliação da valência diferente, independentemente dos estímulos, em relação aos controles. Já quando consideramos a escala de arousal os pacientes sentem-se mais ativados do que os controles, exceto nos estímulos desagradáveis. Contudo, os resultados obtidos na medição objetiva dos seus correlatos fisiológicos não são congruentes com a avaliação cognitiva que realizam, uma vez que mostraram menor reatividade aos estímulos independentemente da sua condição emocional. Conclusão: Estes resultados mostram que indivíduos com LEA têm dificuldade em fazer uma avaliação coerente do seu estado de ativação fisiológico. Por essa razão, é altamente recomendado o uso simultâneo de medidas psicofisiológicas.(AU)

Introduction: Self-report measures have been used in the study of emotions, namely the valence and arousal scales of the Self-Assessment Manikin (SAM), which provide a subjective cognitive appraisal of different emotional dimensions. However, cognitive assessment ability in patients with acquired brain injury (ABI) may be compromised. Consequently, their emotional responses measured by self-report may be inconsistent. In these cases, the assessment should include complementary techniques, such as peripheral physiological measures empirically validated for the study of emotions. Method: We evaluated 36 patients with ABI and 33 healthy controls. Both groups watched pleasant, unpleasant and neutral images from the International Affective Picture System (IAPS) and rated them using SAM valence and arousal scales, while their peripheral physiological responses, consisting of skin conductance response (SCR) and heart rate (HR), were recorded. Results: In self-report measures, patients with ABI evaluated valence differently, regardless of stimuli, compared to controls. Regarding the arousal scale, patients with ABI reported feeling more aroused when compared to controls, except in unpleasant stimuli. However, the results obtained in the physiological assessment are not consistent with those of the cognitive assessment, as they showed lower reactivity to stimuli regardless of their emotional condition. Conclusion: These results show that patients with ABI have more difficulty in making a coherent assessment of their physiological arousal. For this reason, the simultaneous use of psychophysiological measures is highly recommended. (AU)

Parameters Influencing Tracheostomy Decannulation in Patients Undergoing Rehabilitation after severe Acquired Brain Injury (sABI)

Abstract Introduction Tracheostomy weaning in patients who suffered a severe acquired brain injury is often a challenge and decannulation failures are not uncommon. Objective Our study objective is to describe the decannulation failure rate in patients undergoing rehabilitation following a severe acquired brain injury (sABI); to describe the factors associated with a successful tube weaning. Methods We conduct a retrospective analysis of charts, consecutively retrieved considering a 3-year window. Variables analyzed were: age, sex, body mass index (BMI), Glasgow Coma Scale (GCS), cause of hospitalization (stroke, trauma, cardiac arrest), date of the pathological event, gap between the index event and the first day of hospitalization, duration of Neurorehabilitation Ward hospitalization, comorbidities, chest morphological alteration, kind of tracheostomy tube used (overall dimension, cap, fenestration), SpO2, presentation and quantification of pulmonary secretion, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respiratory frequency and pattern, cardiac frequency, presence of spontaneous cough, cough strength, and blood gas analysis. Results We analyzed 45 tracheostomised sABI patients following stroke, trauma, or cardiac arrest. The weaning success percentage was higher in Head Trauma patients and in patients presenting positive spontaneous cough. Failures seem to be associated with presence of secretions and anoxic brain damage. GCS seemed not related to the decannulation outcome. Conclusions Parameters that could be used as positive predictors of weaning are: mean expiratory pressure, presence of spontaneous cough, and cough strength. Provoked cough and GCS were not predictive of weaning success.

Relación entre búsqueda de sensaciones y la toma de decisiones pacientes con daño cerebral adquirido / Relation of sensation seeking and decision making in patients with acquired brain injury

Resumen En este trabajo se evaluó la influencia de la variable cognitiva "búsqueda de sensaciones" en la toma de decisiones en 73 pacientes con daño cerebral adquirido (DCA) a través de un estudio no experimental, transversal y correlacional, mediante la utilización de la Balloon Analogue Risk Task (BART) y la sub escala de búsqueda de sensaciones de la UPPS-P Como grupo control, se aplicaron las pruebas a 30 personas que cumplían con los criterios de inclusión y exclusión propuestos. Se utilizó la BART ya que permite una aplicación más rápida y ofrece una tarea de fácil ejecución y comprensión, que a diferencia de otros instrumentos no requiriere que la persona evaluada presente una capacidad de comprensión verbal compleja bien preservada. Además no existen estudios anteriores que correlacionen ambas pruebas. Como resultado se obtuvieron diferencias significativas entre el grupo clínico y el grupo control donde éste último mostró un nivel mayor de toma de riesgo en la BART y búsqueda de sensaciones en la sub escala UPPS-P. Tomando en cuenta la literatura revisada, los resultados obtenidos y la observación cualitativa del grupo clínico, podríamos sospechar que en la toma de decisionesse halla presente el componente de apatía, y motivación, pudiendo concluir que la búsqueda de sensaciones correlaciona positivamente con el desempeño y elaboración de la toma de decisiones.

Abstract In this paper was evaluated the influence of cognitive variable "sensation-seeking" in decision-making in 73 patients with acquired brain injury (ABI), by means of a non-experimental, cross-sectional and correlational study, through the Balloon Analogue Risk Task (BART) and sensation seeking sub scale of UPPS-P, as control group, test were applied to 30 healthy subjects who met the inclusion and exclusion criteria proposed. The BART is used because allows a faster application and offer a task of easy execution and understanding, unlike others instruments didn't require that evaluated person present a good preserved complex verbal comprehension capability. In addition, there not exist previous studies correlating both tests. As result significant differences between the clinical and the control group where the last one showed a higher level of risk taking in the BART and sensation seeking in the sub scale UPPS-P. Considering the literature reviewed the results and qualitative observation of clinical group. We might suspect that in decision-making is present the apathy and motivation component. Being able to conclude that sensation-seeking correlate positively with elaboration and performance of decision-making.

Reliability and Validity of Chinese Version of Rivermead Behavioural Memory Test-Third Edition among Chi-nese Population / 中国康复理论与实践

Objective To analyze the reliability and validity of the Chinese version of the Rivermead Behavioural Memory Test-Third Edition (RBMT-III). Methods The items of RBMT-III were translated in Chinese and adjusted. A total of 131 healthy subjects were tested with Chinese version of RBMT-III, 30 of them were tested again with other materials two weeks later. Results The Cronbach'sαcoefficient was 0.799. The correlation coefficient of parallel-forms in subtest scale and meory index were all more than 0.65. There were six main fac-tors extracted, which explained 64.47%of the accumulated variance, those were novel task learning, spatial memory, verbal memory, visual memory, prospective memory and orientation/date. Conclusion RBMT-III is a reliable and validated instrument for assessment of memory.

Influencia de la memoria de trabajo y la flexibilidad cognitiva en la ejecución de la tarea balloon analogue risk task / Influence of Working Memory and Cognitive Flexibility in Performance of the Balloon Analogue Risk task

Diversos estudios plantean la importancia que tienen las funciones ejecutivas como la flexibilidad cognitiva, la inhibición y la memoria de trabajo en la toma de decisiones. En este estudio se pretende valorar si la memoria de trabajo y la flexibilidad cognitiva, procesos cognitivos presentes en la toma de decisiones, pueden explicar las alteraciones en el rendimiento de los pacientes con daño cerebral adquirido (DCA) en la Balloon Analogue Risk Task (BART). A 73 pacientes con DCA se les administró la BART, el Trail Making Test (TMTB) y el Wisconsin Card Sorting Test (WCST), para valorar la flexibilidad cognitiva; y el subtest Letras y Números (LN) del WAIS-III para evaluar la memoria de trabajo. Los mismos test fueron administrados a un grupo control de 30 sujetos sin DCA. En el grupo clínico, las variables neuropsicológicas estudiadas incluidas para explicar la variación del BART$ fueron TMTB, p < .001, y WCST, p <.001. Observamos que únicamente la flexibilidad cognitiva valorada con WCST y TMTB pudo explicar las alteraciones en el rendimiento de los pacientes con DCA en la BART. Por tanto, es lógico pensar que si el rendimiento de la BART depende de la flexibilidad cognitiva de estos pacientes, entonces es de esperar que dicha capacidad sea un buen factor predictivo en la toma de decisiones.

A number of studies have raised the importance of certain executive functions such as attention, cognitive flexibility, response inhibition, and working memory in decision-making. The purpose of this study is to prove whether or not working memory and cognitive flexibility, capacities present in decision-making, can explain the changes in the performance of patients with acquired brain damage in Balloon Analogue Risk Task (BART). 73 patients with adult Acquired Brain Injury (ABI) were assessed with the BART, Trail Making Test B (TMTB), Wisconsin Card Sorting Test (WCST) to asses cognitive flexibility; and subtest Letter-Number (LN) of WAIS -III to asses working memory. The same test was administered to a control group of 30 subjects without ABI. In the clinical group, the only variables studied that were included to explain the variation in BART$ were TMTB, p < .001, and WCST, p < .001. We observe that changes in the performance of our patients with ABD in BART could only be explained by cognitive flexibility. Therefore we can conclude that performance in BART depends on the cognitive flexibility of these patients; therefore, it is to be expected that this capacity will be a good predictor of decision-making.

Malestar psicológico en familiares de pacientes con daño neurológico durante la fase subaguda de NeuroRehabilitación / Psychological distress in relatives of patients with neurological damage during the subacute phase of NeuroRehabilitation

Durante la última década la Neurorehabilitación ha comenzado a prestar mayor atención a las familias de personas que adquieren un daño neurológico. Este giro parece responder a un creciente número de estudios describiendo importantes niveles de malestar psicólogico en dichas familias y advirtiendo de su impacto en el proceso de rehabilitación. En Chile, lamentablemente, no contamos con estudios que exploren el estado emocional de familiares en ninguna de las etapas de rehabilitación, esto, a pesar de existir guías clínicas que sugieren el abordaje familiar como meta central. Dicha falta de información limita tanto la capacidad diagnóstica como interventiva de los equipos de rehabilitación. El objetivo de este artículo es describir, y comparar, el perfil de malestar psicológico en familiares de personas con lesión cerebral y medular en etapa subaguda de rehabilitación. Método. 89 familiares de personas con daño neurológico (Lesión Cerebral Adquirida = 50; Trauma Raquimedular = 39) respondieron el General Health Questionnaire-28 como medida de malestar psicológico. Este instrumento que se compone de cuatro subescalas: síntomas somáticos, ansiedad e insomnio, disfunción social y depresión grave. Resultados. En ambas poblaciones el puntaje total del GHQ-28 se observó por encima de los estándares poblacionales, sugiriendo niveles clínicos de malestar psicológico en 90 por ciento de la muestra. No se observaron diferencias entre ambas poblaciones en términos de puntaje total o puntaje de subescalas, sugiriendo similares perfiles de malestar psicólogico. Dicho perfil se caracterizó por altos niveles de ansiedad e insomnio, seguido en menor grado de síntomas somáticos...

During the last decade NeuroRehabilitation has begun to pay more attention to the families of people with neurological damage. This shift seems to respond to a growing number of studies describing significant levels of psychological distress in families, and warning professionals of its potential impact in the process of rehabilitation. In Chile, unfortunately, we have no studies that explore the emotional state of families in any stage of the rehabilitation process, this, despite the existence of clinical guidelines suggesting to address family needs as a central goal. This lack of information limits rehabilitation teams’ ability as well as their capacity to develop interventions. The aim of this article is to describe, and compare, the profile of psychological distress in relatives of people with brain damage and spinal cord injuries, during the sub-acute phase of rehabilitation. Method. 89 relatives of people with neurological damage (Acquired Brain Injury = 50; Spinal Cord Injury = 39) completed the General Health Questionnaire-28, a self-report measure of psychological distress. This instrument has four subscales, each of them screening for different types of symptoms: somatic, anxiety/insomnia, social dysfunction and severe depression. Results. Both neurological groups presented GHQ-28 total scored above population standards, thus suggesting clinical levels of psychological distress in 90 percent of the sample. No differences were observed between the two groups in terms of GHQ-28 total score or subscale score, thus, suggesting similar profiles of psychological distress. High levels of anxiety and insomnia, followed to a lesser degree by somatic symptoms, characterized this profile...

Validación de un programa de estimulación neuropsicológico NEUROPROTENIC en pacientes con daño cerebral adquirido / Validation of a neuropsychological stimulation program NEUROPROTENIC in patients with acquired brain injury

El objetivo de la presente investigación fue realizar el diseño de un software de estimulación neuropsicológica denominado NEUROPROTENIC y validación de las actividades incluidas en el software, como proyecto de grado para el programa de Maestría en Neuropsicología Clínica de la Facultad de Psicología de la Universidad de San Buenaventura. Esta es la primera fase general del estudio que posteriormente será sistematizado e implementado en pacientes que han presentado daño cerebral adquirido, específicamente aquellos con las etiologías correspondiente a accidente cerebrovascular y trauma cráneo encefálico. En el contexto actual de investigaciones sobre rehabilitación neuropsicológica y/o estimulación neuropsicológica, se ha iniciado una tendencia mayor al uso de nuevas herramientas tecnológicas, por tanto es quizás por esto la gran oportunidad de NEUROPROTENIC de ser un software pionero en Colombia que se somete a validación las actividades de rehabilitación, consiguiendo un alto índice de validez en las actividades diseñadas lo que garantiza en una gran parte que realmente que las personas con Daño Cerebral Adquirido que participen de la estimulación neuropsicológica mediante presenten una mejoría significativa en la curva de recuperación espontanea...

The objective of this research is to design software called NEUROPROTENIC neuropsychological stimulation, as degree project for Master of Clinical Neuropsychology, Faculty of Psychology at the University of San Buenaventura. This generally is the first phase of the study which will later be systematized and implemented in patients who have acquired brain injury, specifically those corresponding to the stroke etiologies and Traumatic Brain Injury. In the current context of neuropsychological rehabilitation research and / or neuropsychological stimulation, has started a greater tendency to use new technological tools, so it is perhaps for this NEUROPROTENIC the great opportunity to be a pioneer in Colombia that software undergoes validation rehabilitation activities, achieving high level of validity in activities designed which guarantees really much that people with Acquired Brain Injury to participate by presenting neuropsychological stimulation significantly improved the spontaneous recovery curve...

Working with families following brain injury

It has been recognised for several decades that a moderate to severe acquired brain injury frequently causes a high level of psychological stress within the immediate family, who often provide long-term care and support. However, although there is an abundance of research evidence for family burden and stress following brain injury, research into the effectiveness of psychological interventions designed to support such families is relatively scarce. This paper will summarise some of the existing research literature and examine the clinical process of working with families following acquired brain injury. After a brief and selective review of the evidence for caregiver stress following brain injury, we will consider some theoretical models and concepts relevant to family work, and the existing research evidence regarding family interventions. We will then focus on our experience of working with families in clinical practice and our approach will be illustrated using a case study...

Correlación entre el examen mínimo del estado mental y la escala de memoria de Wechsler en una muestra de pacientes con daño cerebral / Correlation between mini mental state examination and the Wechsler memory scale in a sample of patients with sequel

Introducción. La afectación de los procesos cognitivos es muy frecuente en pacientes con daño cerebral adquirido (DCA). Una adecuada evaluación neuropsicológica permite arribar a un diagnóstico certero de la magnitud del déficit y su repercusión funcional. Este estudio examina la correlación entre un test de cribado tradicional, el Examen Mínimo del Estado Mental (MMSE) y un test específico para la evaluación de la memoria, la Escala de Memoria de David Wechsler-I (WMS-I), en una muestra de 124 pacientes con DCA. Para ello se empleó el Método de Pearson. La correlación global obtenida entre ambos test fue significativa (p≤0.05) Conclusiones. Los test de cribado constituyen una manera breve y práctica para aproximarnos al diagnóstico neuropsicológico y este estudio de correlación constata la sensibilidad y el valor predictivo del MMSE como uno de los test de rastreo más empleados en la práctica clínica para orientar la exploración de las funciones comprometidas tras la lesión cerebral. No obstante, consideramos que en modo alguno deberían sustituirse las pruebas neuropsicológicas por los test de cribado para evaluar cognición en pacientes con daño cerebral adquirido.

Introduction. The cognitive impairments are frequently in patients with acquired brain injury (ABI). The neuropsychological assessment must provide a good diagnosis of the severity and functional repercussion of the cognitive impairments. This study examines the correlation between a traditional screening test, Mini–Mental State Examination (MMSE) and a specific test for the memory evaluation, the Wechsler Memory Scale I (WMS)I, in a sample of 124 patients with sequel of ABI. The global correlation (using coefficient of Pearson) between MMSE and WMS I was statistical significant (p≤0.05). Conclusions. The screening test constitutes an easy and brief way to obtain an adequate neuropsychological diagnosis. This correlation verifies the sensibility and the predictor value of the MMSE like one of the most employees test in the clinical practice to guide the exploration by damaged functions after the brain injury. Nevertheless, we consider that neuropsychological assessment in acquired brain injury patients should not be substituted by a scrutiny instrument.

Efficacy of Rehabilitation on Attention Deficits / 中国康复理论与实践

@#Objective To compare the efficacy of different models of attention rehabilitation on attention deficits after acquired brain injury. Methods According to the training models, 47 patients with attention deficits were randomly assigned to 3 groups: computer-assisted training group(n=16), face-to-face training group(n=21) and control group(n=10). The training groups were given attention training once a day which sustained 30 minutes for 6 weeks. All patients were tested with the Montreal Cognitive Assessment (MoCA) and the Loewenstein Occupational Therapy Cognitive Assessment Battery (LOTCA) before and 6 weeks after the rehabilitation. Results The performance of both the computer-assisted training group and the face-to-face training group significantly improved (P<0.05). The various of the scores was the most in the computer-assisted training group among them (P<0.05). Conclusion The computer-assisted training is a high-effective method for attention deficits.

Efficacy of Rehabilitation on Acalculia after Acquired Brain Injury / 中国康复理论与实践

@#Objective To compare the efficacy of different rehabilitation models on acalculia after acquired brain injury. Methods 113 cases were randomly assigned to 3 groups: control group(n=37), computer-assisted training group(n=38) and face-to-face training group(n=38). The control group just received cognitive dysfunction evaluation. The training groups received cognitive rehabilitation training 5 days a week and 30 minutes a day which sustained for 6 weeks. And 33 patients were selected to prolong for 12 weeks. They were evaluated with Revised EC301Calculation and Number Processing Battery in Chinese version (EC301-CR) at the beginning, the 6th week point and the 12th week point respectively. Results 6-week after treatment, The performance of both the computer-assisted training group and face-to-face training group significantly improved(P<0.001); It showed that computer-assisted group>face-to-face group>control group(P<0.001) both 6 weeks and 12 weeks latter. Significant negative correlation was found between age and performance of EC301-CR(P<0.05).Conclusion The effect of computer-assisted training on acalculia is superior to face-to-face training; The first 6 weeks of training is the best period for rehabilitation; The younger the patient is, the better results are.

Efficacy of Rehabilitation on Memory Disorders / 中国康复理论与实践

@#Objective To investigate the effect of rehabilitation on memory deficits after acquired brain injury, to compare different training models of memory rehabilitation and to analyze the possible factors affecting memory rehabilitation. Methods 144 patients with acquired brain injury following memory deficits were randomly assigned to computer-assisted training group, face-to-face training group and control group. Both training groups were given memory-based cognitive training program once a day which sustained 30 minutes for 6 or 12 weeks. The instantaneous memory, short-term memory and long-term memory were evaluated and compared before and after training. The effect of gender, age, education, course, site of injury and coma time on training efficacy were analyszed as well. Results 6 weeks and 12 weeks at training, both computer-assisted and face-to-face training groups showed a significant improvement in memory abilities when compared to controls (P<0.01), with the former making more progress (P<0.01). Negative correlation was found between age and memory performance. Conclusion Effectiveness of memory rehabilitation is proven. 12 weeks training can significantly improve memory. Cognitive training using professional equipment is significantly more effective than the face-to-face training and should be recommended.

Reliability and Validity of Revised EC301Calculation and Number Processing Battery in Chinese Version / 中国康复理论与实践

@#Objective To analyze the reliability and validity of Revised EC301Calculation and Number Processing Battery in Chinese version (EC301-CR); To establish diagnostic criteria by EC301-CR for acalculia in order to provide an effective assessment tool clinically. Methods The items of EC301were adjusted. 103 patients with acquired brain injury and 37 normal controls were randomly selected. 24 normal controls randomly selected were retested 6 weeks latter. Results The Cronbach's coefficient, the split-half reliability and the retest reliability coefficients were 0.907, 0.744, and 0.965, respectively. The correlation coefficient within subscales was more than the correlation coefficient between subscales. 4 first-order factors were extracted which accounted for 69.359% of the accumulated variance, which were mental calculation, number transcoding, written calculation and approximation, and understanding of numbers. Control data (n=37) showed that the P10 of EC301-CR was 222.6. Conclusion The critical value of acalculia is 222.6 in EC301-CR test. Psychometric properties analysis shows that EC301-CR is a reliable and validated instrument for acalculia.

Enfoques y fundamentos para un modelo de rehabilitación ambulatoria en personas con lesión cerebral adquirida / Approaches and foundations for a model of outpatient rehabilitation in people whit acquired brain injury

Introducción: Un porcentaje significativo de personas que adquieren una lesión cerebral necesita programas de rehabilitación ambulatoria. En Chile predomina aún un modelo biomédico de rehabilitación, no obstante, las nuevas guías clínicas recomiendan un abordaje interdisciplinario que considere las necesidades del paciente y su familia. Actualmente existe un vacío respecto a cómo operacionalizar intervenciones eficaces que respondan a este paradigma. Objetivo: Encontrar evidencia que permita el desarrollo y evaluación de enfoques en neurorehabilitación ambulatoria de personas con lesión cerebral adquirida y las posibles metodologías de operacionalización de estos. Metodología: Revisión inductiva y conceptual de la literatura. Resultados: En la literatura chilena no existe evidencia empírica ni desarrollos sistemáticos sobre los fundamentos y la efectividad de los programas de rehabilitación ambulatoria para estas personas. En la literatura internacional se destacan tres enfoques: el enfoque holista, el centrado en el cliente y el basado en la planificación de metas. Si bien tales enfoques permiten guiar las acciones de los equipos, la evidencia de su efectividad, en base al criterio de expertos y pequeños estudios longitudinales y de caso único, es aun limitada. Conclusiones: Esencial a la construcción de identidad de un equipo de rehabilitación es determinar los principios y enfoques que sustente su labor. La complejidad y diversidad de los pacientes en la fase ambulatoria requiere que los equipos posean claros fundamentos para guiar la constante toma de decisiones. Es necesaria la evaluación de la eficacia de los programas de rehabilitación ambulatoria en Chile, desarrollando metodologías acordes a la naturaleza multifactorial del fenómeno.

Introduction: A significant percentage of people who acquire a Brain Injury need outpatient rehabilitation programs. In Chile the rehabilitation field is in a transitional stage. Even though the biomedical model is predominant in rehabilitation, the clinical guidelines have begun to recommend an interdisciplinary approach that considers patients needs and their families. Now-a-days, there is a gap on how to operationalize effective interventions responding to this paradigm. Objectives: To find evidence that sustains the development and assessment of outpatient neurorehabilitation approaches of people with brain injury and, to describe the possible operationalization methodologies of these. Methodology: Inductive and conceptual review of literature. Results: In Chilean Literature does not exist empirical evidence nor systematic developments on the foundations and effectiveness of outpatient rehabilitation programs for people with brain injury. International Literature describes three approaches: holistic, client centered, and goal-based. While such approaches can guide the team actions, the evidence of their effectiveness, based on expert criteria and small longitudinal studies and single case studies is still limited. Conclusions: For the development of a rehabilitation team identity, it is essential to determine the principles and approaches that support their work. Due to complexity and diversity of patients in the ambulatory phase, it is crucial that teams have clear foundations to guide the constant decision making. The evaluation of the effectiveness of ambulatory programs in Chile is a necessity; also it is to develop methodologies according to the nature of the phenomenon.

The Effect of Comprehensive Intensive Treatment on Social Participation in Persons with Acquired Brain Injury / The Japanese Journal of Rehabilitation Medicine

The purpose of this study was to estimate the effect of our post-acute comprehensive intensive inpatient treatment (Program A) on persons with acquired brain injury in the hospital. Program A, designed for work or school, consists of daily six hours sessions for three months, personal and group sessions, and family support. It was designed to build cognitive and behavioral skills through a transdisciplinary approach and 17 patients with acquired brain injury were enrolled in the program. Seventeen program non-participants were selected as our control. Cognitive functions were measured with FIM, WAIS-III, RBMT, and TMT before and after the program. Significant cognitive improvements (especially attention) and increased societal participation were obtained for the Program A participants compared with non-participants. Considering that Program A improved both the cognitive function and level of social participation in program participants, we suggest that it is valuable to perform intensive treatment programs in an inpatient condition for acquired brain injury patients.

Técnicas de rehabilitación neuropsicológica en daño cerebral adquirido: ayudas de memoria externas y recuperación espaciada / Neuropsychological rehabilitation techniques in acq uired brain injury: External memory aids and spaced retrieval

Este artículo tuvo como objetivo realizar una revisión de las técnicas de recuperación espaciada y de ayudas de memoria externas, para la rehabilitación de personas con daño cerebral adquirido. Inicialmente se expusieron las alteraciones cognitivas y funcionales comunes en personas con daño cerebral y, posteriormente se describieron cada una de las técnicas, indicando en qué consiste cada una de ellas y mostrando los resultados de las investigaciones revisadas. Se determinó que la principal utilidad de las técnicas de recuperación espaciada y ayudas de memoria externas fue en el tratamiento de dificultades de memoria, aunque sólo en algunas ocasiones se evaluaron mejorías en medidas neuropsicológicas. La utilización de ayudas de memoria externas fue la técnica que en más ocasiones demostró ganancias en funcionalidad y mantenimiento a largo plazo.

The purpose of this article is to carry out a review of the spaced retrieval and external memory aids techniques for the rehabilitation of people with acquired brain injury. Initially, the common cognitive and functional deficits in acquired brain injury were exposed; later, each technique was described, indicating what each one consists in and the results of the studies reviewed. At last, it was determined that, spaced retrieval and external memory aids were mainly used for the treatment of memory deficits, although only in few cases the gains in neuropsychological measures were evaluated. The external memory aids technique was the one that more often showed functional gains and follow up maintenance.

Psicoterapia e intervenciones terapéuticas en sobrevivientes de lesión cerebral adquirida / Psychotherapy and therapeutic interventions in acquired brain injury survivors

The place of psychotherapy in the rehabilitation processes of Acquired Brain Injury survivors is reviewed in this article. The main difficulties that psychotherapy has found to validate itself as a useful tool are summarized. The psychotherapy's primary goals are to facilitate the adhesion to rehabilitation and the emotional adaptation to physical, cognitive and behavioural changes. Finally, some directives in the use of this clinical tool are enumerated, differentiating between psychotherapeutic process and therapeutic interventions.

En este artículo se revisa el lugar de la psicoterapia en los procesos de rehabilitación de sobrevivientes de Lesión Cerebral Adquirida. Se resumen las principales dificultades que ha encontrado la psicoterapia para validarse como una herramienta útil. Los objetivos principales de la psicoterapia son facilitar la adherencia al tratamiento y la adaptación emocional a los cambios físicos, cognitivos y conductuales. Finalmente, se enumeran algunas directrices en el uso de esta herramienta clínica, diferenciando además entre procesos psicoterapéuticos e intervenciones terapéuticas.