Reaprendizaje motor orientado a tareas en pacientes con secuelas de enfermedad cerebro vascular: una revisión narrativa

Introducción: en personas con secuelas de enfermedad cerebro-vascular (ECV), la rehabilitación debe ser integral, con un enfoque funcional. En la actualidad, existe una técnica que lo posibilita desde un componente motriz, el reaprendizaje motor orientado a tareas (MRP). Como objetivo, se planteó establecer, a partir de la revisión de la literatura, los efectos de la técnica para miembros superiores, inferiores e independencia funcional en pacientes con secuelas de ECV. Métodos: se realizó una revisión narrativa a partir de consulta de bases de datos en línea (Pubmed, Elsevier, Lilacs, Scholar) y se incluyó literatura con información relevante acerca de fundamentación teórica. Resultados: el entrenamiento con esta técnica reporta efectos, en miembros inferiores, para mejoría de balance y marcha, y a nivel de miembros superiores, en funciones como alcances y agarres, lo que se traduce en una optimización de su independencia funcional. Conclusión: este programa puede ser una opción en la rehabilitación de la función motora en pacientes con estas secuelas.

Introduction: Rehabilitation must be comprehensive with a functional approach in people with sequels of Vascular Brain Disease VBD. There is a technique that allows this through a motor component named task-oriented motor relearning (TMR), it was established as objective to identify based on the literature review the effects of the technique for upper and lower limbs and functional independence in patients with sequels of VBD. Methods: A narrative review was carried out based on online databases (Pubmed, Elsevier, Lilacs, Scholar). Literature with relevant information about theoretical foundation was included. Results: The training with this technique reports effects on lower limbs to improve balance and gait, and for upper limbs in functions such as scopes and grips that results in an optimization of functional independence. Conclusion: This program may be an option for motor function rehabilitation in patients with these sequels.

Introdução. A reabilitação deve ser parte integrante de uma abordagem funcional em pessoas com sequelas de doença cerebrovascular DCV. Existe uma técnica que o faz possível a partir de um componente motriz chamado reaprendizagem motora orientada por tarefa (MRP). O objetivo foi estabelecer a partir da revisão da literatura os efeitos da técnica para membros superiores e inferiores e independência funcional em pacientes com sequelas de DCV. Métodos. Foi realizada uma revisão narrativa a partir da busca em bases de dados online (Pubmed, Elsevier, Lilacs, Scholar), incluindo literatura com informações relevantes sobre fundamentação teórica. Resultados. O treinamento com essa técnica relata efeitos nos membros inferiores para melhorar o equilíbrio e a marcha, no nível dos membros superiores em funções como escopos e manoplas que resultam em uma otimização da independência funcional. Conclusão. Este programa pode ser uma opção na reabilitação da função motora em pacientes com essas sequelas.

Atención post hospitalaria de pacientes con accidente cerebrovascular en atención primaria de salud / Hospital post attention of patients with vascular brain accident in primary health care

Resumen Introducción: el desarrollo constante de estrategias locales de prevención, promoción, acciones curativas y de rehabilitación para personas con Accidente Cerebrovascular, permite reducir la letalidad, discapacidad y complicaciones. OBJETIVO: elaborar un Plan de Intervención Integral para la atención post hospitalaria de pacientes con Accidente Cerebrovascular en un Centro de Salud Familiar chileno. MÉTODOS: para diseñar el plan fue necesario elaborar un diagnóstico situacional, identificar los factores de riesgo, y caracterizar la población durante el periodo del 2009-2013. Luego junto a directivos, referentes técnicos y Equipo de Salud Cardiovascular se identificaron las estrategias de educación, cuidado y tratamiento que conformaron el plan. Resultados: entre un 40% a un 50% de las personas con Accidente Cerebrovascular presentan secuelas que requieren algún grado de apoyo, es por ello que el Plan de Intervención Integral integra diferentes profesionales de la salud, los que a través de terapias y técnicas colaboran para conseguir una situación funcional, familiar y social lo más próxima a la que el paciente tenía previo al accidente. CONCLUSIÓNES: un enfoque integral e interdisciplinario desde la atención primaria permite disminuir las complicaciones prevenibles, apoyar e integrar al paciente y a su familia en el proceso de tratamiento, disminuir el grado de discapacidad, optimizar los resultados funcionales y la reintegración social

Abstract Introduction: The constant development of local strategies for prevention, promotion, curative and rehabilitation actions for people with Vascular Brain Accident, can reduce lethality, disability and complications. Objective: to develop an Integral Intervention Plan for the post-hospital care of patients with Vascular Brain Accident in a Chilean Family Health Center. METHODS: to design the plan it was necessary to develop a situational diagnosis, identify the risk factors, and characterize the population during the period 2009-2013. Next, along with managers, technical referents and cardiovascular health team, the education, care and treatment strategies that shaped the plan were identified. Results: between 40% and 50% of people with Vascular Brain Accident have sequelae that require some degree of support, which is why the Integral Intervention Plan integrates different health professionals, who through therapies and techniques collaborate To achieve a functional, family and social situation as close as the patient had before the accident. CONCLUSIONS: a comprehensive and interdisciplinary approach from primary care allows reducing preventable complications, supporting and integrating the patient and his family in the treatment process, reducing the degree of disability, optimizing functional outcomes and social reintegration.

Representação artística das consequências neurológicas do Acidente Vascular Encefálico, nas obras de Otto Dix (1891-1969), a partir de seus 76 anos / Artistic representation of the neurological consequences of stroke in the works of Otto Dix (1891-1969), from the age of 76 / Representación artística de las consecuencias neurológicas del Accidente Vascular Encefálico en las obras de Otto Dix (1891-1969), a partir de sus 76 años

As doenças cerebrovasculares atingem cerca de 17 milhões de indivíduos por ano mundialmente, encontrando-se, entre elas, o Acidente Vascular Encefálico (AVE), que se caracteriza por déficit neurológico súbito decorrente de alteração vascular focal. No presente estudo, reporta-se o caso do pintor alemão Otto Dix, acometido por AVE no hemisfério direito, aos 76 anos. Em decorrência do episódio, desenvolveu heminegligência e hemiparesia à esquerda, hemianopsia, distúrbio de construção visuoespacial moderado, e apraxia associada ao déficit de propriocepção do membro superior esquerdo. Descrevem-se as mudanças na representação visual nas obras produzidas por ele, após a doença, a fim de correlacionar as consequências neurológicas através da expressão gráfica.

Cerebrovascular diseases reach about 17 million individuals per year worldwide, including Stroke, which is characterized by sudden neurological deficit due to focal vascular alteration. In the present study, the case of the German painter Otto Dix, affected by stroke in the right hemisphere, at 76 years of age, is reported. As a result of the episode, he developed left hemielegiation and hemiparesis, hemianopsia, moderate visuo-spatial construction disorder, and apraxia associated with proprioception deficit of the left upper limb. The changes in the visual representation in the works produced by him, after the illness, are described in order to correlate the neurological consequences through graphic expression.

Las enfermedades cerebrovasculares alcanzan a cerca de 17 millones de individuos por año en todo el mundo, encontrándose entre ellas el Accidente Vascular Encefálico (AVE), que se caracteriza por déficit neurológico súbito resultante de alteración vascular focal. En el presente estudio, se reporta el caso del pintor alemán Otto Dix, acometido por AVE en el hemisferio derecho, a los 76 años. En consecuencia del episodio, desarrolló heminexia y hemiparesia a la izquierda, hemianopsia, disturbio de construcción visuoespacial moderado, y apraxia asociada al déficit de propriocepción del miembro superior izquierdo. Se describen los cambios en la representación visual en las obras producidas por él, después de la enfermedad, a fin de correlacionar las consecuencias neurológicas a través de la expresión gráfica.

Verbal fluency in right brain damage: dissociations among production criteria and duration.

This study aimed to verify dissociations in the performance of verbal fluency tasks with different production criteria and duration following vascular right-hemisphere damage. We tested the hypothesis that longer fluency tasks would be more sensitive in identifying deficits in the sample. The relationship between verbal fluency performance and sustained attention was also investigated. Forty adults with vascular right-hemisphere damage were assessed using verbal fluency tasks with three different production criteria (unconstrained, phonemic, and semantic fluencies from the Montreal Communication Evaluation Battery). Performance deficits in 1-min and 2-min fluency tasks were calculated (Z score) and compared (chi-square). Results did not suggest a difference in sensitivity between the task lengths in detecting cognitive impairment. However, double dissociations were found, highlighting the contribution of extended verbal fluency tasks to neuropsychological assessment. Analyses also showed that participants exhibited greater levels of impairment in the semantic fluency task. No relationship was identified between performance in sustained attention tasks and verbal fluency tasks, regardless of the latter's duration. The combined use of longer and shorter fluency tasks in the assessment of patients with right brain damage may contribute to the identification of different executive function impairments in this sample.