[Interindividual variability in patients with visuospatial neglect: a retrospective study]. / Variabilidad interindividual en pacientes con heminegligencia visuoespacial: estudio retrospectivo.

INTRODUCTION: Patients who have suffered a stroke may present with visuospatial neglect (VSN). In clinical practice, different degrees of impairment can be observed among patients with VSN; however, there is no consensus regarding the criteria and tests used to determine them. AIM: This study aims to classify patients with VSH based on their level of impairment and to study their response to computerized cognitive training. PATIENTS AND METHODS: The sample consisted of 34 patients (19 men and 15 women) with a mean age of 47.59 ± 8.39 years. All patients underwent a neuropsychological exploration protocol composed of specific tests that assess visuospatial attention and others to evaluate multiple cognitive domains. All participants underwent computerized cognitive training consisting of 15 one-hour sessions. RESULTS: A cluster analysis was performed that divided the sample into three groups: group 1: mildly affected VSN (n = 17), group 2: moderately affected VSN (n = 11), and group 3: severely affected VSN (n = 6). Statistically significant differences were found in all tests of the visuospatial attention protocol, both in the pre-treatment and post-treatment evaluation. CONCLUSIONS: There are different levels of impairment among patients with VSN, differences that persist after applying computerized cognitive training. These results suggest that the evolution of VSN follows a homogeneous pattern linked to the initial level of impairment. These findings, although preliminary, may be relevant to neurorehabilitation professionals.

TITLE: Variabilidad interindividual en pacientes con heminegligencia visuoespacial: estudio retrospectivo.Introducción. Los pacientes que han sufrido un ictus pueden presentar heminegligencia visuoespacial (HVE). En la práctica clínica es posible observar diferentes grados de afectación entre los pacientes con HVE; sin embargo, no existe consenso respecto a los criterios y pruebas utilizadas para determinarlos. Objetivo. Este estudio tiene como objetivo clasificar a los pacientes que presentan HVE en función de su nivel de afectación y estudiar su respuesta a un entrenamiento cognitivo computarizado. Pacientes y métodos. La muestra estaba formada por 34 pacientes (19 hombres y 15 mujeres) con una edad media de 47,59 ± 8,39 años. A todos los pacientes se les administró un protocolo de exploración neuropsicológico compuesto por pruebas específicas que evalúan la atención visuoespacial y otro para evaluar múltiples dominios cognitivos. Todos los participantes realizaron un entrenamiento cognitivo computarizado consistente en 15 sesiones de una hora de duración. Resultados. Se realizó un análisis de conglomerados que dividió la muestra en tres grupos: grupo 1, HVE con afectación leve (n = 17); grupo 2, HVE con afectación moderada (n = 11); y grupo 3, HVE con afectación grave (n = 6). Se obtuvieron diferencias estadísticamente significativas en todas las pruebas del protocolo de atención visuoespacial, tanto en la evaluación pretratamiento como en la postratamiento. Conclusiones. Existen diferentes niveles de afectación entre los pacientes con HVE, diferencias que se mantienen después de aplicar un entrenamiento cognitivo computarizado. Estos resultados sugieren que la evolución de la HVE sigue un patrón homogéneo vinculado al nivel de afectación inicial. Estos hallazgos, aunque preliminares, pueden ser relevantes para los profesionales de la neurorrehabilitación.

Rehabilitation of social cognition impairment after traumatic brain injury: a systematic review.

INTRODUCTION: Many studies have described the presence of difficulty processing and generating social behaviour in patients who have suffered a traumatic brain injury (TBI). These difficulties in social cognition (SC) deteriorate personal relationships in the family, at work, or in the community. However, therapeutic programmes aiming to improve SC continue to be an outstanding issue in clinical practice. We performed a systematic review of the existing literature on the recovery of SC in patients with TBI, assessing the methodological quality of the included studies and the therapeutic effectiveness of the rehabilitation strategies used. DEVELOPMENT: We performed a bibliographic search of papers published before June 2018 in the Medline/PubMed, Google Scholar, PsycINFO, and ClinicalTrials.gov databases. Of the 198 potentially relevant articles, 10 met our eligibility criteria. Two of the authors independently and blindly assessed the methodological quality of these studies using the PEDro scale. CONCLUSIONS: The articles included in this systematic review essentially studied the effect of different interventions aimed at the rehabilitation of SC in patients with chronic TBIs. The analysis showed adequate methodological quality and an acceptable level of evidence. Future research should analyse the effect of these interventions in patients with TBIs in the sub- and post-acute phases.

Rehabilitación de la cognición social en el traumatismo craneoencefálico: una revisión sistemática / Rehabilitation of social cognition impairment after traumatic brain injury: A systematic review

Introducción: Múltiples estudios han descrito la presencia de dificultades para procesar y generar conductas de tipo social en pacientes que han sufrido un traumatismo craneoencefálico (TCE). Tales dificultades, englobadas bajo el término genérico de cognición social (CS), provocan un deterioro en las relaciones personales, tanto a nivel familiar como laboral o comunitario. No obstante, los programas terapéuticos dirigidos a la mejora de la CS continúan siendo una asignatura pendiente en la práctica clínica. El objetivo de este trabajo es realizar una revisión sistemática de la literatura existente sobre rehabilitación de la CS en pacientes con TCE, valorar su calidad metodológica y la efectividad terapéutica de las estrategias rehabilitadoras empleadas.DesarrolloSe realizó una búsqueda bibliográfica hasta junio de 2018 en las bases de datos Medline/PubMed, Google Scholar, PsycInfo y ClinicalTrials.gov. De los 198 artículos potencialmente interesantes, 10 cumplieron los criterios de elegibilidad. Dos de los autores evaluaron, de forma independiente y ciega, la calidad metodológica de los estudios incluidos en la revisión mediante la escala PEDro.ConclusionesLos artículos incluidos en esta revisión sistemática han estudiado esencialmente el efecto de diferentes intervenciones dirigidas a la rehabilitación de la CS en pacientes con TCEs en fase crónica. El análisis muestra que su calidad metodológica es adecuada y que el nivel de evidencia es aceptable. Se constata la necesidad de analizar el efecto de estas intervenciones en pacientes con TCE en fases subaguda y postaguda. (AU)

Introduction: Many studies have described the presence of difficulty processing and generating social behaviour in patients who have suffered a traumatic brain injury (TBI). These difficulties in social cognition (SC) deteriorate personal relationships in the family, at work, or in the community. However, therapeutic programmes aiming to improve SC continue to be an outstanding issue in clinical practice. We performed a systematic review of the existing literature on the recovery of SC in patients with TBI, assessing the methodological quality of the included studies and the therapeutic effectiveness of the rehabilitation strategies used.DevelopmentWe performed a bibliographic search of papers published before June 2018 in the Medline/PubMed, Google Scholar, PsycINFO, and ClinicalTrials.gov databases. Of the 198 potentially relevant articles, 10 met our eligibility criteria. Two of the authors independently and blindly assessed the methodological quality of these studies using the PEDro scale.ConclusionsThe articles included in this systematic review essentially studied the effect of different interventions aimed at the rehabilitation of SC in patients with chronic TBIs. The analysis showed adequate methodological quality and an acceptable level of evidence. Future research should analyse the effect of these interventions in patients with TBIs in the sub- and post-acute phases. (AU)

Neuropsychological rehabilitation for post-COVID-19 syndrome: results of a clinical programme and six-month follow up.

INTRODUCTION: Patients with post-COVID-19 syndrome may present cognitive and emotional symptomatology. This study aims to analyse the results of an outpatient neuropsychological intervention programme for post-COVID-19 syndrome. METHOD: In June 2020 Institut Guttmann started an outpatient post-COVID-19 neurorehabilitation programme, including respiratory therapy, physiotherapy, and neuropsychological rehabilitation. Before and after the programme, the cognitive-emotional state of all participants is assessed. Six months after treatment, a follow-up assessment is administered (which includes a collection of information on various aspects of daily life). RESULTS: The sample analysed consisted of 123 patients (mean age: 51 years, SD: 12.41). Seventy-four per cent (n = 91) had cognitive impairment and underwent cognitive treatment (experimental group); the remaining 26% (n = 32) constituted the control group. After the intervention, the experimental group improved in working memory, verbal memory (learning, recall and recognition), verbal fluency and anxious-depressive symptomatology. The control group showed changes in immediate memory, verbal memory (learning and recognition) and depressive symptomatology, although the effect size in the latter two was smaller than in the experimental group. Six months after treatment, 44.9% of the patients were unable to perform their pre-COVID-19 work activity, and 81.2% reported difficulties in their activities of daily living. CONCLUSIONS: Neuropsychological rehabilitation is an effective tool to treat the cognitive-emotional deficits present in post-COVID-19 syndrome. However, months after the end of treatment, not all patients recover their pre-COVID-19 functional level.

Computerized social cognitive training in the subacute phase after traumatic brain injury: A quasi-randomized controlled trial.

OBJECTIVES: To assess the usefulness of a computerized tasks module designed for the rehabilitation of social cognition (SC) in acquired brain injury. METHODS: Quasi-randomized controlled trial (ClinicalTrials.gov:NCT03479970) involving 45 patients with moderate-severe traumatic brain injury (TBI) in a subacute inpatient rehabilitation hospital. The experimental group (n = 28) received treatment with a computerized SC module in combination with a non-SC module. The control group (n = 26) only received a treatment with non-SC module. RESULTS: Intragroup comparisons showed that the experimental group had better results for all SC measures, except for International Affective Picture System (IAPS). The control group improved for Facial Expressions of cEmotion-Stimuli and Tests (FEEST) and Moving Shapes Paradigm (MSP), showing no changes with respect to pretreatment in IAPS, MSP and Reading the Mind in the Eyes Test (RMET). Intergroup comparisons did not present differences between the two groups for pretreatment measures. Post-treatment comparison showed that the experimental group obtained better results for RMET than the control group. CONCLUSION: The computerized SC module was useful for the rehabilitation of SC in patients with moderate-severe TBI in the subacute phase. The group that received combined rehabilitative treatment (SC + non-SC) obtained better results for SC than the group that received treatment intended only for non-SC.

Social and nonsocial cognition: Are they linked? A study on patients with moderate-to-severe traumatic brain injury.

OBJECTIVES: The first aim was to study the relationship between Social Cognition (SC) and nonsocial Cognition (n-SC) measures in a group of patients with moderate or severe traumatic brain injury (TBI) to assess the dependence or independence of both types of cognition. The second aim was to explore the relationships between SC measures and generate a model based on the results of these relationships. METHODS AND PROCEDURES: Forty-three subacute patients with TBI were included in the study. They were administered a SC battery and n-SC battery. SC battery included the following measures: International Affective Picture System (IAPS); Facial Expressions of Emotion-Stimuli Test (FEEST); Moving Shapes Paradigm (MSP); Reading the Mind in the Eyes Test- Revised Version (RMET); Social Decision Making Task (SDMT). n-SC battery included Digit Span Forwards and Backwards; Trail Making Test (Part A); Rey's Auditory Verbal Learning Test; Letter-Number Sequencing; and verbal fluency test (PMR). RESULTS: FEEST, MSP and RMET were related to n-SC measures. The exploratory factor analysis shows a two-factor SC structure: Factor 1: Emotional recognition and mentalization (FEEST, MSP and RMET) and Factor 2: Acquisition and contextualization (IAPS and SDMT). CONCLUSION: The performance of subjects with moderate-to-severe TBI in the SC measures is related, at least partially, by the performance in the n-SC measures. Our SC model shows a two-factor structure characterized by a first factor that brings together SC measures that are highly related to n-SC domains and a second factor that brings together measures whose performance is not influenced by n-SC domains.

[The effect of traumatic brain injury on social decision making]. / Efecto del traumatismo craneoencefalico en la toma de decisiones sociales.

INTRODUCTION: Patients with traumatic brain injury (TBI) can present difficulties in making decisions of a social nature. Such difficulties condition complicate their personal relationships. AIMS: To assess social decision-making in a sample of patients with moderate and severe TBI, and to empirically contrast if, as Ochsner's social-emotional processing model proposes, the ability to recognize and respond to socio-affective stimuli is related to the ability to regulate sensitive responses to the context based on the proposed assessment tests. SUBJECTS AND METHODS: Twenty-one patients with a moderate and severe TBI (experimental group) matched by gender, age and years of education with 24 healthy subjects (control group). Social decision making was measured through the Social Decision Making Test (SDMT), and the ability to recognize and respond to socio-affective stimuli through the Pictures of Facial Affect (PoFA) test. RESULTS: Statistically significant differences in the SDMT were obtained between the experimental group and the control group. Regarding PoFA, the performance of the control group was also significantly better than that of the experimental group. However, no relationship was observed between the performance in the SDMT and the PoFA for any of the groups. CONCLUSIONS: The SDMT seems to be a sensitive test to detect alterations in social decision making in patients with moderate or severe TBI. No relationship was observed between the results in the SDMT and the PoFA.

TITLE: Efecto del traumatismo craneoencefalico en la toma de decisiones sociales.Introduccion. Los pacientes con traumatismo craneoencefalico (TCE) pueden presentar dificultades para tomar decisiones de tipo social. Tales dificultades condicionan un deterioro en sus relaciones personales. Objetivos. Valorar la toma de decisiones de tipo social en una muestra de pacientes con TCE moderado y grave y contrastar empiricamente si, como defiende el modelo de procesamiento socioemocional de Ochsner, la capacidad para reconocer y responder a estimulos socioafectivos se relaciona con la capacidad para regular respuestas sensibles al contexto basandose en las pruebas de valoracion propuestas. Sujetos y metodos. Muestra de 21 pacientes con TCE moderado y grave (grupo experimental), emparejados por sexo, edad y años de escolaridad con 24 sujetos sanos (grupo control). La toma de decisiones de tipo social se valoro mediante el Social Decision Making Test (SDMT), y la capacidad para reconocer y responder a estimulos socioafectivos, mediante el Pictures of Facial Affect (PoFA). Resultados. Se obtuvieron diferencias estadisticamente significativas entre el grupo experimental y el grupo control en el SDMT. Respecto al PoFA, el rendimiento del grupo control tambien fue sensiblemente mejor que el del grupo experimental. Sin embargo, no se observo relacion entre el rendimiento en el SDMT y el PoFA para ninguno de los grupos. Conclusiones. El SDMT parece ser una prueba sensible para detectar alteraciones en la toma de decisiones sociales en pacientes con TCE moderado o grave. No se ha observado relacion entre los resultados del SDMT y el PoFA.

[Rehabilitation of anosognosia in patients with unilateral visuospatial neglect]. / Rehabilitacion de la anosognosia en pacientes con heminegligencia visuoespacial.

INTRODUCTION: Patients with unilateral visuospatial neglect secondary to a stroke are usually unaware of the fact that their perception and exploration of contralesional space are deficient. This clinical phenomenon, know as anosognosia, directly conditions the rehabilitation process and prolongs its duration to a significant extent, while also making it more difficult for the patient to adhere to it. AIM: To assess the efficacy of a specific rehabilitation programme for the treatment of anosognosia in patients presenting with unilateral visuospatial neglect. PATIENTS AND METHODS: Twelve patients with a stroke in the right hemisphere were divided into two groups. The experimental group received 15 sessions of computerised cognitive therapy along with 15 sessions of specific rehabilitation for anosognosia. The control group underwent 15 sessions of computerised cognitive treatment. All of them were administered, before and after treatment, a battery of tests to evaluate visuospatial attention. The level of functionality was evaluated by means of the Catherine Bergego Scale. RESULTS: After the intervention, the control group showed statistically significant psychometric differences. The same did not occur with the experimental group. No differences were obtained in the pre- and post-treatment intergroup comparisons, or in the psychometric measures or on the functional scale. CONCLUSIONS: Further research is needed to help us improve the treatment of anosognosia in patients with unilateral visuospatial neglect. Some methodological recommendations emerge from the limitations identified in this study.

TITLE: Rehabilitacion de la anosognosia en pacientes con heminegligencia visuoespacial.Introduccion. Habitualmente, el paciente con heminegligencia visuoespacial secundaria a un ictus no es consciente de que su percepcion y exploracion del espacio contralesional son defectuosas. Este fenomeno clinico, conocido como anosognosia, condiciona directamente el proceso rehabilitador y amplia sensiblemente su duracion, al tiempo que dificulta la adhesion del paciente a dicho proceso. Objetivo. Valorar la eficacia de un programa de rehabilitacion especifico para el tratamiento de la anosognosia en pacientes que presentan heminegligencia visuoespacial. Pacientes y metodos. Se distribuyo a 12 pacientes con ictus hemisferico derecho en dos grupos. El grupo experimental recibio 15 sesiones de tratamiento cognitivo informatizado junto con 15 sesiones de rehabilitacion especificas para la anosognosia. El grupo control realizo 15 sesiones de tratamiento cognitivo informatizado. A todos ellos se les administro, antes y despues del tratamiento, una bateria de test para evaluar la atencion visuoespacial. El nivel de funcionalidad se valoro mediante la Catherine Bergego Scale. Resultados. Tras la intervencion, el grupo control mostro diferencias psicometricas estadisticamente significativas. No sucedio lo mismo con el grupo experimental. No se obtuvieron diferencias en las comparaciones intergrupales pre y postratamiento, ni en las medidas psicometricas ni en la escala funcional. Conclusiones. Es necesario seguir realizando investigaciones que nos ayuden a mejorar el tratamiento de la anosognosia en pacientes que presentan heminegligencia visuoespacial. Se plantean algunas recomendaciones metodologicas surgidas de las limitaciones identificadas en el presente estudio.

Rehabilitation of social cognition impairment after traumatic brain injury: A systematic review. / Rehabilitación de la cognición social en el traumatismo craneoencefálico: una revisión sistemática.

INTRODUCTION: Many studies have described the presence of difficulty processing and generating social behaviour in patients who have suffered a traumatic brain injury (TBI). These difficulties in social cognition (SC) deteriorate personal relationships in the family, at work, or in the community. However, therapeutic programmes aiming to improve SC continue to be an outstanding issue in clinical practice. We performed a systematic review of the existing literature on the recovery of SC in patients with TBI, assessing the methodological quality of the included studies and the therapeutic effectiveness of the rehabilitation strategies used. DEVELOPMENT: We performed a bibliographic search of papers published before June 2018 in the Medline/PubMed, Google Scholar, PsycINFO, and ClinicalTrials.gov databases. Of the 198 potentially relevant articles, 10 met our eligibility criteria. Two of the authors independently and blindly assessed the methodological quality of these studies using the PEDro scale. CONCLUSIONS: The articles included in this systematic review essentially studied the effect of different interventions aimed at the rehabilitation of SC in patients with chronic TBIs. The analysis showed adequate methodological quality and an acceptable level of evidence. Future research should analyse the effect of these interventions in patients with TBIs in the sub- and post-acute phases.