Computer-assisted training of executive functions in adult patients with non-progressive acquired brain damage - a pilot study on efficacy of a new therapeutic application.

Executive dysfunction is most often caused by post-traumatic or post-stroke damage to the prefrontal regions of the brain. The aim of this study was to compare the efficacy of two computer-assisted therapy programs for executive dysfunctions in patients with acquired brain injury. Patients were trained using either a newly developed application ExeSystem (designed to help improve the ability to manage and control one's own behavior by performing tasks imitating natural, everyday situations) or a combination of two commercial applications RehaCom and CogniPlus. Data collected after a three-week period of therapy conducted in two 15-person groups of participants indicated comparable efficacy of both therapy programs in improving quality of daily functioning, executive attention, as well as planning and problem-solving but not memory. The improvement in social competence (p = .028) was the only advantage of therapy with the ExeSystem. Therapeutic interactions using computer programs were shown to be positively evaluated by patients (p < .01). This study confirmed at least equal efficacy of computer-based executive function therapy using ExeSystem compared to RehaCom and CogniPlus. However, despite the implementation of a more ecological and comprehensive approach to the content of a new application, the benefits of this approach were limited.

Alternating Hemiplegia of Childhood in Two Adult Patients with a Mild Syndrome.

We describe the cognitive-behavioral functioning of two adult patients with a mild form of alternating hemiplegia of childhood (AHC). AHC is a rare, chronic neurodevelopmental syndrome manifesting in infancy or early childhood, with recurrent hemiplegic or hemidystonic attacks, various nonepileptic paroxysmal events, and cognitive-behavioral impairments, including mental delay of varying degrees. We conducted neurologic and neuroimaging examinations, as well as a neuropsychological assessment, of two men (22 and 30 years old) with mutations in the ATP1A3 gene (p.Leu757Pro and p.Val332Glu) who were experiencing typical AHC transient episodes of alternating weakness or paralysis in order to investigate causes of their poor social functioning. During neurologic examinations of both patients, which were performed between attacks, we observed involuntary movements such as chorea and upper-limb tremor. One patient also had dysarthria. Magnetic resonance imaging revealed no parenchymal brain lesions or atrophy in either patient. Neuropsychological examinations demonstrated near-normal (patient 1) or normal (patient 2) global cognitive functioning, with some isolated executive functioning deficits. Both patients had emotional and social dysfunction as well as difficulties adapting to normal adult life. Although the clinical presentation of AHC is usually dramatic, some patients have mild forms of the syndrome (eg, no significant intellectual disability). However, motor and movement disorders, as well as coexisting emotional-affective abnormalities, may affect these patients' ability to adapt to independent life.

Post-stroke pure apraxia of speech - A rare experience.

Apraxia of speech (AOS) is a motor speech disorder, most typically caused by stroke, which in its "pure" form (without other speech-language deficits) is very rare in clinical practice. Because some observable characteristics of AOS overlap with more common verbal communication neurologic syndromes (i.e. aphasia, dysarthria) distinguishing them may be difficult. The present study describes AOS in a 49-year-old right-handed male after left-hemispheric stroke. Analysis of his articulatory and prosodic abnormalities in the context of intact communicative abilities as well as description of symptoms dynamics over time provides valuable information for clinical diagnosis of this specific disorder and prognosis for its recovery. This in turn is the basis for the selection of appropriate rehabilitative interventions.

Neuropsychological and neurological sequelae of out-of-hospital cardiac arrest and the estimated need for neurorehabilitation: a prospective pilot study.

BACKGROUND: Diffuse brain injury is a key component of post-cardiac arrest syndrome reported in 30-80% of survivors of out-of-hospital cardiac arrest (OHCA). It is responsible for a high mortality rate, and is a common cause of cognitive and neurological deficits and disability. Symptom variability and dynamics and the rehabilitation potential remain poorly understood. AIM: To investigate symptom prevalence, type, and severity and the natural course of recovery within 12 months after OHCA, and to estimate neurorehabilitation needs. METHODS: Study participants were selected from OHCA survivors admitted consecutively to a cardiac intensive care unit (CICU) serving 250,000 of Warsaw's inhabitants, according to the following inclusion criteria: first ever nontraumatic, normothermic cardiac arrest, age ≤ 75 years; cardiology ward survival until discharge, and no history of pre-existing brain disease. Patients' cognitive and neurological status and disability were evaluated in the first days after onset and three, six and 12 months later. Neuropsychological assessment focused on attention, memory, executive, linguistic and visuo-spatial abilities. Neurological examination included assessment of cranial nerves, muscle strength and tone, deep tendon reflexes, cerebellar function, sensory function, and gait. The general psychophysical state was classified using the Disability Rating Scale. Patients' neurorehabilitation needs were determined using data collected three months post-OHCA. This data was used to estimate future demands for such resources in Poland. RESULTS: During a 28-month study period, of 69 OHCA patients admitted to the CICU, 29 met the study criteria (33 survived until discharge from cardiology unit; four did not meet further criteria). Severe consciousness disorders were most frequent in the early post-OHCA phase (28%); no unresponsive patients were identified 12 months later. Of responsive patients who were capable of at least minimal co-operation, 100% (early after OHCA) to 57% (12 months after OHCA) had cognitive impairment, usually with neurological symptoms. Memory impairment was the most common and severe problem, followed by executive, attentional, language and visuo-spatial dysfunctions. The prevalence of neurological deficits ranged from 88% (early after OHCA) to 43% (12 months after OHCA). Due to acquired deficits, between 71% (early post-OHCA) and 36% (12 months post-OHCA) of patients were significantly disabled and often dependent. Although dysfunctions tended to improve, over 50% of the patients remained impaired 12 months post-OHCA, and over 30% were significantly disabled. We estimated that about 800 OHCA survivors/year in Poland will develop symptoms requiring neurorehabilitation. CONCLUSIONS: Cognitive and neurological symptoms are common after cardiac arrest brain injury. Establishing specialised neurorehabilitation centres is essential for treating these patients.

Anodal transcranial direct current stimulation in early rehabilitation of patients with post-stroke non-fluent aphasia: a randomized, double-blind, sham-controlled pilot study.

PURPOSE: Recent research in patients with chronic aphasia shows an association between excitatory anodal transcranial direct current stimulation (A-tDCS) of the stroke-affected left hemisphere coupled with speech and language therapy (SLT) and better language performance. The present study aimed to investigate this association during the early post-stroke rehabilitation period, when adaptive changes are most possible on neurophysiological and behavioral levels. METHODS: We randomized 24 patients with non-fluent aphasia to receive 15 consecutive sessions (5 days/week for 3 weeks) of A-tDCS (1 mA, 10 min; n = 14) or sham tDCS (S-tDCS: 1 mA, 25 sec; n = 10) over Broca's area followed by 45-min SLT. Naming ability was assessed before the rehabilitation, after its completion, and three months later. RESULTS: Both groups significantly improved after the therapy. There were no statistically significant between-group differences in the short-term or long-term tDCS effects on naming accuracy and naming time. The A-tDCS group obtained higher effect sizes in naming time, both post-treatment and at the 3-month follow-up, suggesting potential benefits of the stimulation. CONCLUSIONS: The findings provide only weak evidence for A-tDCS-related language gains during early neurorehabilitation of post-stroke aphasia. Further research is needed to explore the effectiveness of this kind of neuromodulation.