La relación entre la percepción del cuidador sobre los síntomas derivados del daño cerebral en personas con traumatismos craneoencefálicos y su propia Salud Mental / Relationship between caregivers’ perception of Traumatic brain injury symptoms and caregiver’s mental health

Objetivo: Determinar si existe una relación entre la percepción que tiene el cuidador de los síntomas que presentan los pacientes con traumatismos craneoencefálicos (TCE) y su salud mental. Participantes: Se entrevistó a 50 cuidadores de individuos con TCE de la ciudad de Barranquilla, Colombia, a quienes se les aplicó la escala de satisfacción con la vida, la versión en español del Patient Health Questionary-9, la escala de sobrecarga de Zarit, la escala de autoestima de Rosenberg, el inventario de ansiedad estado-rasgo y un cuestionario de 22 preguntas que evaluó la percepción de síntomas del individuo con TCE, compuesto por cuatro grupos de síntomas: cognitivos, neuroconductuales, físicos y sociales. Resultados: Los análisis de correlación canónica revelaron que a mayor número de síntomas que se perciben en el paciente, peor es la salud mental que tienen los cuidadores, específicamente se encontró que a mayor percepción de síntomas neuroconductuales en el paciente mayor sobrecarga, mayor depresión y menor autoestima en el cuidador. Conclusiones: Los resultados sugieren la necesidad de desarrollar e implementar programas de intervención psicoterapéutica, así como terapia de rehabilitación cognitiva, con el fin de reducir o eliminar los problemas neuroconductuales en personas con TCE en Colombia. De igual forma, es importante el diseño de intervenciones que trabajen de manera paralela con los cuidadores y familiares para orientarlos respecto al impacto que puede tener el TCE tanto en la vida del paciente, como en la familia, brindándoles, además, herramientas para manejar la aparición de problemas emocionales, como la depresión, la baja autoestima y la sobrecarga (AU)

Objective: To determine the system of connections between mental health and symptoms perception of caregivers of individuals with traumatic brain injury (TBI) in Barranquilla, Colombia. Participants: 50 caregivers of individuals with TBI completed the Satisfaction with Life Scale, PHQ-9 (depression), Zarit Burden Interview, Rosenberg Self-Esteem Scale, State-Trait Anxiety Inventory, and a 22-question TBI symptoms perception inventory composed of four component areas: cognitive symptoms, neurobehavioral symptoms, physical symptoms and social symptoms. Results: A canonical correlation analysis revealed that the higher the caregivers’ symptoms perception, the worse their mental health was, with the effect reaching a large-sized effect. Furthermore, a pattern emerged linking caregivers’ higher perception of neurobehavioral symptoms to higher caregivers’ burden, depression, and lower self-esteem. Conclusions: These findings suggest the need for rehabilitation health professionals to develop and implement culturally-appropriate interventions to reduce neurobehavioral symptoms in people with TBI, interventions to improve self-steem, reduce depression symptoms, and burden in Colombian caregivers of individuals with TBI (AU)

Déficits neuropsicológicos asociados a la relación entre abuso de cocaína y violencia: mecanismos neuronales facilitadores / Neuropsychological impairments associated with the relation between cocaine abuse and violence: neurological facilitation mechanisms

Introducción. El abuso de la cocaína, así como la exposición prenatal a la misma parece ser un factor relevante en el desencadenamiento de comportamientos violentos. Los déficits neuropsicológicos, así como el género y la combinación con el alcohol, serían los posibles mecanismos facilitadores. Objetivo. Revisar y recapitular los resultados obtenidos sobre los déficits neuropsicológicos debidos al abuso o a la exposición prenatal a la cocaína y relacionarlos con la expresión de la violencia. Además, se enfatiza el papel del género y el abuso del alcohol junto a la cocaína, así como la posible existencia de daño orgánico cerebral como mecanismos facilitadores. Desarrollo. Se ha revisado la bibliografía científica usando los buscadores Google Scholar, PsycINFO, PubMed, Medline e ISI Web of Knowledge. Conclusiones. La cocaína facilitaría la expresión de la violencia debido a los déficits en la decodificación emocional, la capacidad de abstracción e inhibición, así como en las habilidades verbales y mnémicas. Esto explicaría, además, los problemas en la toma de decisiones. Los déficits y la expresión de la violencia parecen ser más evidentes en los hombres. Sin embargo, a pesar de que la combinación de la cocaína con el alcohol incrementaría el riesgo de reaccionar de forma violenta, los déficits no serían mayores que el consumo de cada una de ellas por separado. Estos déficits podrían ser producto de un funcionamiento anormal de algunas áreas del lóbulo frontal (especialmente el prefrontal) y el parietal, así como estructuras subcorticales como la amígdala. Todo ello permitiría planificar estrategias de intervención cuyos objetivos serían estos dominios cognitivos

Introduction. Cocaine abuse, as well as prenatal exposure to cocaine, could be key factors in the expression of violent behaviour. Neuropsychological impairments, sex differences and the concurrent abuse of cocaine and alcohol have been suggested as facilitation mechanisms. Aims. To review and recapitulate the results obtained on the relationship between neuropsychological deficits due to cocaine abuse and/or prenatal exposure and the expression of violence. Furthermore, we analyze the roles of sex, concurrent alcohol abuse and possible brain damage as risk markers in this relationship. Development. The scientific literature was reviewed using Google Scholar, PsycINFO, PubMed, Medline and ISI Web of Knowledge. Conclusions. Cocaine facilitates the expression of violence due to neuropsychological deficits in emotional decoding, abstract reasoning and inhibitory control, as well as in mnemonic and verbal skills, and such impairments might also explain problems in decisionmaking. Both the deficits and the expression of violence appear to be more pronounced in men than in women. However, despite the fact that the combination of cocaine and alcohol use may increase the risk of violent reactions, the deficits would not be greater than those resulting from the separate use of each substance. The impairments might be caused by functional abnormalities of certain regions of the frontal (especially the prefrontal) and parietal lobes and some subcortical structures, such as the amygdala. All of this would provide a basis for the development of intervention strategies focusing on these cognitive domains

Recognizing and managing concussion in school sport.

Every country around the world enjoys some sort of sport. The Olympics sees countries from all over the globe participate in elite sport, in both winter and summer competitions. Australia is widely known for cricket and rugby; America is known for baseball and gridiron football (among others). These sports are played at an elite level as well as beginners from early ages as young as 4 years in the backyard. Yet, it is also these sports that can deliver a ball at the speed of 100 km/h (football), 105 km/h (baseball), 112 km/h (rugby), 150 km/h (cricket), and 211 km/h (soccer). This is the same force that a car collision can produce. That force eventually finds a target, and in some cases, unfortunately, it is a head. Damage to the brain is not only from the impact of the ball hitting its target but rather also the shearing forces of acceleration-deceleration injury that can cause extensive injuries. There has been much discussion of late regarding concussion in sport and the accumulative effects of head blows resulting in varying degrees of memory loss and dementia later in life. The media have been saturated with heightened awareness of chronic traumatic encephalopathy. This, however, is still being researched. It is true that each concussion compounds the one before, but rather than focus on the injury, managers/coaches and sporting codes should be focusing on the identification and proper management of a suspected concussion and the return-to-play protocols. This is especially important in our schools where growing brains need nurturing. Neuroscience nurses are at the forefront of educating school children, teachers, and coaches through partnering with local schools. This article will focus on concussion recognition and management in school sport.

[Work after brain damage: unpredictability of outcomes]. / Le travail après une lésion cérébrale, l'imprévisibilité des trajectoires.

The Unit for Evaluation, Re-Education and Socio-Professional Orientation (UEROS) is a bridge between the hospital environment and professional life. It assists brain-damaged patients with their social and professional reintegration while taking into account their specific needs.

How do you know when your patient is "waking up": coma recovery assessment in a complex continuing care setting.

Coma, vegetative state (VS) and minimally conscious state (MCS) are disastrous outcomes following severe traumatic brain injury. Due to the extent of the resultant neurological deficits including hemisphere damage, loss of cellular integrity, altered and abnormal movements such as flexor and extensor patterns, and alterations in cranial nerve function, it can become difficult for the interprofessional team to identify when a patient is emerging from their coma. The Glasgow Coma Scale (GCS), commonly used to assess patients with traumatic brain injury (TBI) is not comprehensive or sensitive enough to provide concrete evidence that a patient is emerging from VS to an MCS. The purpose of this paper is to present a case study of a patient who has emerged from a persistent VS to promote a deeper understanding of what is involved when working with this clientele. Challenges in assessment of cognitive functioning, the development of successful communication through the use of technology and the goals of therapy amongst the various health team members will be provided. Collaborative support with the family will also be discussed. Members of the interprofessional team explored the literature to determine coma recovery assessment tools and best evidence guidelines to direct their interventions with this patient.

[Burden of primary caregivers of young patients with brain damage].

OBJECTIVES: The objective of this study was to shed light on (1) the extent to which primary caregivers of patients with brain damage feel nursing-care burden, and (2) the relationship between such burden and other attributes in a cross-sectional manner. METHODS: We conducted an anonymous questionnaire survey of primary caregivers of young patients with brain damage. The survey was conducted between November 2008 and March 2009. The number of valid responses was 53 (response rate 56%). To assess burden of caregivers, we used the Short Version of the Japanese Version of the Zarit Caregiver Burden Interview (J-ZBI_8). RESULTS: With regard to burden felt by primary caregivers "concerns about excretion" and "problematic behavior" were stressed. Individuals who were less than 50 in age most strongly felt burden. Moreover, burden was greater for spouses than for guardians. CONCLUSION: In order to reduce the burden of caregivers in case of primary caregivers, rehabilitation concerning young patients with brain damage and efforts to enhance their capabilities are important. In addition, it is also necessary to provide social resources so that primary caregivers can rely on other persons without worry.