[Towards a comprehensive theory of the rehabilitation of cerebral function as a basis for programmes of rehabilitation in brain damaged patients]. / Hacia una teoría comprensiva de la rehabilitación de funciones cerebrales como base de los programas de rehabilitación en enfermos con daño cerebral.

INTRODUCTION: Definition of the programme on integral rehabilitation needed by each patient after a cerebral lesion is today a clinical challenge which still requires much investigation. The many advances in all fields of the neurosciences give a great stimulus and fresh hope in tackling these problems. For practical advances in treatment it is important that clinicians make an effort to explain which are the theoretical models used in this complex field of the CNS, or which models may be used to develop new programmes of treatment. DEVELOPMENT: In this paper we summarize some of the current models of rehabilitation of psychic and neuropsychological functions based on experience acquired in the rehabilitation of chronic psychiatric patients and the newer findings of neurophysiology, neuro-imaging, neuropharmacology, neuropsychology etc. We also offer suggestions for effective organization of the work of rehabilitation teams. The newer models to be developed in the future should be suitable for the determination of what should be rehabilitated? (altered functions), how? (substitution, restitution, integration, activation, etc.) and when? (in what chronological order should these interventions take place and at what point). CONCLUSION: Work with definite theoretical models on which to base diagnosis and treatment of psychic function would facilitate comparison of results and allow better understanding of the working of the normal brain.

Hacia una teoría comprensiva de la rehabilitación de funciones cerebrales como base de los programas de rehabilitación en enfermos con daño cerebral / towards a comprehensive theory of the rehabilitation of cerebral funcion as a basis for programmes of rehabilitation in brain damaged patients

Introduction. Definition of the programme on integral rehabilitation needed by each patient after a cerebral lesion is today a clinical challenge which still requires much investigation. The many advances in all fields of the neurosciences give a great stimulus and fresh hope in tackling these problems. For practical advances in treatment it is important that clinicians make an effort to explain which are the theoretical models used in this complex field of the CNS, or which models may be used to develop new programmes of treatment. Development. In this paper we summarize some of the current models of rehabilitation of psychic and neuropsychological functions based on experience acquired in the rehabilitation of chronic psychiatric patients and the newer findings of neurophysiology, neuro-imaging, neuropharmacology, neuropsychology etc. We also offer suggestions for effective organization of the work of rehabilitation teams. The newer models to be developed in the future should be suitable for the determination of what should be rehabilitated? (altered functions), how? (substitution, restitution, integration, activation, etc.) and when? (in what chronological order should these interventions take place and at what point). Conclusion. Work with definite theoretical models on which to base diagnosis and treatment of psychic function would facilitate comparison of results and allow better understanding of the working of the normal brain (AU)

Introducción. Definir el programa de rehabilitación integral que precisa cada paciente tras una lesión cerebral supone hoy en día un reto clínico que requiere todavía de numerosas investigaciones. Los múltiples avances en todos los campos de las neurociencias suponen un importante estímulo y una nueva esperanza a la hora de abordar estos problemas. Para poder avanzar en el tratamiento de una forma pragmática, es importante que los clínicos hagamos un esfuerzo por explicar sobre qué modelos teóricos basamos nuestras actuaciones en este complejo campo del SNC, o partiendo de dichos modelos desarrollar nuevos programas de tratamiento. Desarrollo. En estetrabajo se resumen algunos de los modelos actuales dentro de la rehabilitación de funciones psíquicas y neuropsicológicas basados en las aportaciones de la experiencia acumulada en la rehabilitación de pacientes psiquiátricos crónicos, y en las nuevas aportaciones de la neurofisiología, neuroimagen, neurofarmacología, neuropsicología, etc. Asimismo, aportamos sugerencias para la adecuada organización del trabajo de los equipos de rehabilitación. Los nuevos modelos que se desarrollen en el futuro deben ser capaces de determinar ¿qué se debe de rehabilitar? (funciones alteradas) ¿cómo? (sustitución, restitución, integración, activación, etc.) y ¿cuándo? (en qué orden cronológico realizar estas intervenciones y en qué momento). Conclusión. El trabajar sobre modelos teóricos definidos, en los que basar las intervenciones diagnósticas y terapéuticas sobre el funcionamiento psíquico, facilitará la comparación de resultados y permitirá conocer mejor el funcionamiento del cerebro normal (AU)