Resting-State Beta-Band Recovery Network Related to Cognitive Improvement After Stroke.

Background: Stroke is the second leading cause of death worldwide and it causes important long-term cognitive and physical deficits that hamper patients' daily activity. Neuropsychological rehabilitation (NR) has increasingly become more important to recover from cognitive disability and to improve the functionality and quality of life of these patients. Since in most stroke cases, restoration of functional connectivity (FC) precedes or accompanies cognitive and behavioral recovery, understanding the electrophysiological signatures underlying stroke recovery mechanisms is a crucial scientific and clinical goal. Methods: For this purpose, a longitudinal study was carried out with a sample of 10 stroke patients, who underwent two neuropsychological assessments and two resting-state magnetoencephalographic (MEG) recordings, before and after undergoing a NR program. Moreover, to understand the degree of cognitive and neurophysiological impairment after stroke and the mechanisms of recovery after cognitive rehabilitation, stroke patients were compared to 10 healthy controls matched for age, sex, and educational level. Findings: After intra and inter group comparisons, we found the following results: (1) Within the stroke group who received cognitive rehabilitation, almost all cognitive domains improved relatively or totally; (2) They exhibit a pattern of widespread increased in FC within the beta band that was related to the recovery process (there were no significant differences between patients who underwent rehabilitation and controls); (3) These FC recovery changes were related with the enhanced of cognitive performance. Furthermore, we explored the capacity of the neuropsychological scores before rehabilitation, to predict the FC changes in the brain network. Significant correlations were found in global indexes from the WAIS-III: Performance IQ (PIQ) and Perceptual Organization index (POI) (i.e., Picture Completion, Matrix Reasoning, and Block Design).

Cognitive predictors of self-awareness in patients with acquired brain injury along neuropsychological rehabilitation.

Previous research has identified a critical role of executive function and memory in self-awareness, a metacognitive capacity often impaired in acquired brain injury. Through this observational study, we aimed to explore the effect of cognitive rehabilitation on the predictive value of these variables, as also whether any of them can predict the level of self-awareness once the cognitive rehabilitation is completed. 69 patients underwent a neuropsychological assessment, including self-awareness, at admission to and discharge from a cognitive rehabilitation process. Regression analysis was performed at these two moments and a third one was conducted to evaluate whether any of the variables at admission predicted the level of self-awareness at discharge. Verbal fluency was found to be the best predictor of self-awareness, both at admission and discharge. In addition, inhibition and cognitive flexibility, as well as episodic memory, appeared as significant predictors of post-rehabilitation self-awareness. Finally, verbal fluency was revealed as the unique pre-rehabilitation predictor of subsequent level of self-awareness following rehabilitation. While post-acute self-awareness is predicted by non-specific executive measures, the cognitive improvement putatively induced by neuropsychological rehabilitation reveals the contribution of more specific executive and memory functions. Importantly, pre-rehabilitation verbal fluency scores predicted the level of self-awareness after cognitive rehabilitation.

Self-Awareness Moderates the Association Between Executive Dysfunction and Functional Independence After Acquired Brain Injury.

OBJECTIVE: Impaired self-awareness (SA) is a common symptom after suffering acquired brain injury (ABI) which interferes with patient's rehabilitation and their functional independence. SA is associated with executive function and declarative memory, two cognitive functions that are related to participants' daily living functionality. Through this observational study, we aim to explore whether SA may play a moderator role in the relation between these two cognitive processes and functional independence. METHOD: A sample of 69 participants with ABI completed a neuropsychological assessment focused on executive function and declarative memory which also included a measure of SA and functional independence. Two separated linear models were performed including functional independence, SA, and two neuropsychological factors (declarative memory and executive function) derived from a previous principal component analysis. RESULTS: Moderation analysis show a significant interaction between SA and executive function, reflecting an association between lower executive functioning and poorer functional outcome, only in participants with low levels of SA. Notwithstanding, declarative memory do not show a significant interaction with SA, even though higher declarative memory scores were associated with better functional independence. CONCLUSIONS: SA seems to play a moderator effect between executive function, but not declarative memory, and functional independence. Accordingly, participants with executive deficits and low levels of SA might benefit from receiving specific SA interventions in the first instance, which would in turn positively impact on their functional independence.

Conciencia de déficit como proceso clave en la rehabilitación de pacientes con daño cerebral adquirido: revisión sistemática / Self-awareness as a key process for rehabilitation of patients with acquired brain injury: a systematic review

Introducción: La afectación de la conciencia de déficit es un síntoma habitual de los pacientes que sufren una lesión cerebral, que afecta al proceso rehabilitador y a los logros en términos de independencia funcional del paciente. Pacientes y métodos: Se realizó una revisión sistemática en las bases bibliográficas Scopus y PubMed de los trabajos científicos que han abordado la conciencia de déficit en pacientes con daño cerebral entre 2000 y 2019. Finalmente se revisaron 65 artículos. Resultados: La conciencia de déficit como proceso metacognitivo está ligada a otros procesos cognitivos de orden superior, como las funciones ejecutivas y la memoria. En los últimos años, se han diseñado e implementado programas de intervención específicos sobre conciencia de déficit que han demostrado su eficacia mediante la incorporación de diferentes técnicas (por ejemplo, psicoeducación y feedback). Ante la necesidad de evaluar el éxito de la intervención sobre la conciencia de déficit en términos de mejora funcional, algunos trabajos han estudiado la generalización y la trasferencia de los resultados de la intervención sobre la conciencia de déficit a las actividades de la vida diaria. Conclusiones: La investigación en conciencia de déficit en pacientes con daño cerebral se ha desarrollado de forma significativa en los últimos años, considerando los factores neuropsicológicos, psicológicos y sociales de este fenómeno. Su futuro prometedor apunta hacia su incorporación como cribado en los protocolos de evaluación y, en su caso, su intervención de forma específica, lo que contribuirá a una rehabilitación eficaz que repercuta en la calidad de vida de los pacientes

Introduction: Self-awareness impairment is a common symptom of patients after suffering acquired brain injury, affecting the rehabilitation process and achievements in terms of patients’s daily living functionality. Patients and methods: A systematic review was performed using Scopus and PubMed databases of scientific articles that address self-awareness in patients with brain injury between 2000 and 2019. Finally, 65 articles were reviewed. Results. As a metacognitive process, self-awareness is linked to other higher order cognitive domains such an executive functions and memory. In recent years, specific intervention programs for self-awareness have been developed and implemented, and have proved their effectiveness, by using different techniques (i.e. psychoeducation and feedback). Considering the importance of assessing the success of the self-awareness interventions in terms of functional improvement, some studies have explored the generalization and transfer of results from those interventions to activities of daily living. Conclusions: Research in self-awareness in patients with acquired brain injury has developed significantly in recent years, considering the neuropsychological, psychological and social factors of this phenomenon. The promising future of research in this field points at its inclusion as screening tool in the assessment protocols and, if applicable, its individualized intervention, contributing to an effective global rehabilitation that affects patient's quality of life

Efficacy of an intervention programme for rehabilitation of awareness of deficit after acquired brain injury: A pilot study.

BACKGROUND: Impaired Awareness of Deficit (AD) is a frequent symptom after suffering acquired brain injury (ABI) that severely influences patients' daily lives. PRIMARY OBJECTIVE: Pilot study to assess the effectiveness of a structured intervention programme which was developed from a biopsychosocial approach, and relied on common therapeutic strategies of proven effectiveness. METHODS: We assessed the effectiveness of our intervention on a sample of 60 patients with ABI, 30 of whom received the specific AD intervention programme, while the other 30 followed an equivalent rehabilitation approach where they received no specific intervention on AD. AD were assessed before and after the specific intervention on AD through an ad-hoc designed questionnaire. RESULTS: This study reports that patients who received the proposed programme demonstrated significant improvement in their level of AD, as compared to the control group. This improvement was observable on all the proposed dimensions of awareness. Interestingly, results from correlation analysis also showed that patients with lower initial AD were those who exhibited a greater degree of improvement following the intervention. CONCLUSIONS: This research provides evidence in favour of the effectiveness of implementing an intervention programme for AD in the context a global rehabilitation process for patients with ABI.

Reorganization of functional connectivity as a correlate of cognitive recovery in acquired brain injury.

Cognitive processes require a functional interaction between specialized multiple, local and remote brain regions. Although these interactions can be strongly altered by an acquired brain injury, brain plasticity allows network reorganization to be principally responsible for recovery. The present work evaluates the impact of brain injury on functional connectivity patterns. Networks were calculated from resting-state magnetoencephalographic recordings from 15 brain injured patients and 14 healthy controls by means of wavelet coherence in standard frequency bands. We compared the parameters defining the network, such as number and strength of interactions as well as their topology, in controls and patients for two conditions: following a traumatic brain injury and after a rehabilitation treatment. A loss of delta- and theta-based connectivity and conversely an increase in alpha- and beta-band-based connectivity were found. Furthermore, connectivity parameters approached controls in all frequency bands, especially in slow-wave bands. A correlation between network reorganization and cognitive recovery was found: the reduction of delta-band-based connections and the increment of those based on alpha band correlated with Verbal Fluency scores, as well as Perceptual Organization and Working Memory Indexes, respectively. Additionally, changes in connectivity values based on theta and beta bands correlated with the Patient Competency Rating Scale. The current study provides new evidence of the neurophysiological mechanisms underlying neuronal plasticity processes after brain injury, and suggests that these changes are related with observed changes at the behavioural level.

The ICF: Applications of the WHO model of functioning, disability and health to brain injury rehabilitation.

The traditional disease and diagnostic medical model is not always useful to brain injury professionals who need to describe, measure, and compare deficits associated with neurologic insult. Professionals in neurorehabilitation are in need of new systems that will assist them in identifying impairments and areas of intervention. The aim of this article is to present the International Classification of Functioning, Disability and Health (ICF), and its applications to brain injury rehabilitation. This taxonomy, developed by the WHO, allows the classification and assessment of functioning and disability in everyday activities and social involvement for individuals with medical conditions. Multi-disciplinary teams from 65 countries have collaborated in the development of the ICF to develop a tool that serves different purposes and disciplines with high trans-cultural validity. It can be of great value for professionals working in the field of brain injury who need to describe and quantify in detail neurocognitive, emotional, and sensory-motor functions as well as their impact on activities and participation in life situations. Its applications also extend to the domains of epidemiology, public health and public policy.