Rehabilitación del ictus: modelo asistencial. Recomendaciones de la Sociedad Española de Rehabilitación y Medicina Física, 2009 / Stroke rehabilitation: Care model. Recommendations of the Spanish Society of Physical Medicine and Rehabilitation, 2009

Objetivos: La Sociedad Española de Medicina Física y Rehabilitación elabora un documento de recomendaciones de buena práctica clínica sobre el modelo asistencial en la rehabilitación (RHB) del ictus basadas en la experiencia clínica y el consenso de los autores y las guías de práctica clínica de referencia. Estrategia de búsqueda: La búsqueda se centra en guías de práctica clínica y artículos relevantes sobre el modelo asistencial en la RHB del ictus en las bases de datos MEDLINE, Embase y Cochrane Databases desde enero de 2004 hasta enero de 2009.Selección de estudios: Se seleccionan ensayos clínicos aleatorizados, metaanálisis, revisiones sistemáticas y artículos de revisión sobre el modelo asistencial en la RHB del ictus. Síntesis de resultados: El programa rehabilitador del ictus es un proceso complejo que requiere un abordaje multidisciplinario, siendo elementos claves el inicio precoz, la intensidad adecuada, la evaluación periódica y la participación activa de pacientes y cuidadores. Conclusiones: En todos los niveles de atención sanitaria y sociosanitaria, hospitalaria o comunitaria se debe asegurar la atención de RHB a cargo de un equipo multidisciplinario, coordinada por un médico especialista en RHB con adecuados niveles de organización y experiencia de los profesionales (AU)

Objectives: The Spanish Society of Physical Medicine and Rehabilitation has elaborated a document of good clinical practice recommendations on the care model in stroke rehabilitation based on the clinical experience and consensus of the authors and reference clinical practice guides. Search strategy: The search was focused on clinical practice guides and articles related with the care model in stroke rehabilitation in the MEDLINE, EMBASE and COCHRANE DATABASES from January 2004 to January 2009.Selection of studies Randomized clinical trials, meta-analyses, systematic reviews and review articles on the care model in stroke rehabilitation were selected. Synthesis of results: The stroke rehabilitation program is a complex procedure that requires a multidisciplinary approach. Its key elements are early initiation, adequate intensity, periodic evaluation and active participation of the patients and caregivers. Conclusions: Rehabilitation care under the responsibility of a multidisciplinary team, coordinated by a medical specialist in rehabilitation with adequate levels of organization and experience of the professionals should be assured on all health a and socio-health care, hospital or community levels (AU)

Executive functioning as outcome in patients after traumatic brain injury.

The present study was designed to determine how traumatic brain injury affect executive functioning, to know whether different treatments in the acute phase improve this functioning, and to check whether the severity of the neurocognitive impairment is detected by the Glasgow Outcome Scale (GOS). Ability for problem solving and executive functioning within 2 years after Traumatic Brain Injury (TBI) was examined in 35 conscious survivors. Two groups were formed. One group consisted of 13 patients who needed neurosurgery. The other group was made up of 22 patients without neurosurgical treatment. All were treated in the Neurosurgical Intensive Care Unit and in the Rehabilitation Service. The following variables were registered: Secondary Lesions, Glasgow Coma Scale (GCS), CT, subacute CT, and Glasgow Outcome Scale. Neuropsychological tests administered were Wisconsin Card Sorting Test (WCST) and the Tower of Hanoi/Sevilla. Comparing both groups' test performance (man Whitney U) we found that a severe traumatic brain injury, whatever the treatment applied in the acute phase, impairs the executive functioning of the patients; this impairment is related to acute pathophysiological events. The neurosurgical intervention does not improve the executive functioning. The Glasgow Outcome Scale does not detect more than 25% of the patients with severe impairment. It is suggested that the Tower of Hanoi/Sevilla could be a good tool to evaluate the executive functioning routinely in TBI patients as outcome. It also suggested that mild TBI patients must be referred for a complete neuropsychological examination.

The attentional system in brain injury survivors.

The present study was designed to check the model of attention proposed by Posner and Petersen (1990), in patients with traumatic brain injury. We analyzed a series of neuropsychological tests administered to these patients after they were discharged from the hospital. Scores obtained from this group were subjected to factor analysis. The results of this analysis could be characterized by four factors which accounted for 85.4% of the variance. According to our data, factor 1 (perceptual and motor speed) and factor 2 (vigilance and alertness) represent Posner's posterior attention system. Factor 3 (encoding) and factor 4 (shifting) represent Posner's anterior attention system (AAS), but we have to consider that the AAS is not only attention but is shared by other cognitive processes. The results also suggest that the attention system could be stable and could be defined independently from the type of patient and type of illness.

[Visual constructive deficits and coma depth]. / Déficits visoconstructivos y profundidad del coma.

The present study has the purpose of relating the capacities of visual retention with the Benton Visual Retention Test and the level of coma depth, which is measured with the GCS (Glasgow Coma Scale). 31 subject suffering cranioencephalic damage admitted to the intensive care unit (ICU) have been studied. GCS scores were obtained during their stay in the intensive care unit and the Benton Visual Retention Test was administered after hospital discharge. The procedure followed consists in comparing the performance of subjects with higher GCS scores to subjects with lower values when executing administration. A of form C of BVRT. We could conclude as follows: firstly that BVRT is a useful tool to detect the existence of brain damage; secondly, indexes of brain damage presence with BVRT are: a low figure in correct design, more errors, less errors in distortion and rotation; more errors in the left visual hemifield. Thirdly, the depth of coma is a good prognosis index on BVRT execution and in consequence of visuo-constructive abilities.

The computerized Tower of Hanoi: a new form of administration and suggestions for interpretation.

A computerized version of the Tower of Hanoi with a new form of administration was administered to two different groups, 15 men and 22 women, who were university students reporting normal psychological histories, and 24 traumatically brain-injured patients (20 men and 4 women). Scores on this test for both groups can be interpreted as an index of ability to solve problems and of learning strategies. Men and women scored differently on the task, i.e., women used different strategies than men to solve problems.