The effects of person-centred active rehabilitation on symptoms of suspected Chronic Traumatic Encephalopathy: A mixed-methods single case design.

OBJECTIVE: The objective was to investigate the effectiveness of a person-centred active rehabilitation programme on symptoms associated with suspected Chronic Traumatic Encephalopathy (CTE). This was accomplished by (1) assessing the effect that a person-centred active rehabilitation programme had on participant symptoms, and (2) exploring how temporal contextual factors affected the participants' experience with, and perceived effectiveness of, the active rehabilitation programme. METHODS: A twelve-month mixed-methods single case experimental research design was used with six cases (participants). Individual cases were involved in a 51-week study period including an initial interview and three-week baseline phase. Cases were then randomly allocated to one of two n-of-1 study designs (i.e., A-B, B-A, B-A, A-B or B-A, A-B, A-B, B-A) where A and B represent a non-intervention and intervention phase, respectively. Interviews were conducted regularly throughout the study whilst outcome measures were assessed at each follow-up. Analysis of the data included visual, statistical, and qualitative analysis. RESULTS: Visual and statistical analysis of cognitive and executive function, and mindful attention, demonstrated trivial-to-large effects with the summary reflecting positive or unclear results. A mixed picture was observed for mood and behaviour with effects considered trivial-to-large, and the summary demonstrating positive, unclear and negative effects. Qualitative analysis indicated a perceived improvement in outcome measures such as memory, attention, anxiety, and emotional control despite mixed quantitative findings whilst a clear impact of contextual factors, such as COVID-19, the political atmosphere, exercise tolerance, programme progression, and motivation were evident during the intervention. CONCLUSIONS: This study has provided primary-level evidence to suggest active rehabilitation as a potential intervention for the management of suspected CTE symptoms. This study has also demonstrated the benefit of a person-centred approach to both clinical research and practice, particularly by considering contextual factors for a better understanding of an intervention effect.

Revisión sistemática del tratamiento de la espasticidad en el adulto con daño cerebral adquirido / Systematic review of the treatment of spasticity in acquired adult brain damage

La espasticidad es un trastorno motor, caracterizado por un aumento del tono muscular, y que aparece como consecuencia de un trastorno del sistema nervioso central, dando lugar a déficit y discapacidad, con deterioro de la calidad de vida. En el daño cerebral adquirido del adulto, la espasticidad constituye un problema grave y frecuente, apareciendo en un 20-30% de pacientes con ictus y en un 13-20% de pacientes con traumatismo craneoencefálico moderado-grave. El objetivo principal de este trabajo es realizar una revisión sistemática de los tratamientos utilizados en la espasticidad del paciente adulto con daño cerebral adquirido secundario a ictus y traumatismo craneoencefálico. Como objetivo secundario se pretende averiguar las principales escalas de valoración utilizadas para la medida de la espasticidad en estos pacientes. Se ha realizado una búsqueda sistemática de ensayos controlados aleatorizados, publicados entre el 1 de enero de 2013 y 30 de junio de 2017 en inglés y castellano, en las bases de datos PubMed, Biblioteca Cochrane plus y Ovid. Se han seleccionado finalmente 17 estudios, con una calidad metodológica al menos aceptable, según la escala de Jadad. Los tratamientos más frecuentemente investigados son la toxina botulínica, especialmente el serotipo A, junto a medidas rehabilitadoras. Las escalas clínicas son las más frecuentemente utilizadas para la evaluación de la espasticidad

Spasticity is a motor disorder characterised by an increase in muscle tone that appears as a consequence of a central nervous system disorder, leading to deficit and disability and impairing quality of life. In acquired adult brain damage, spasticity is a severe and frequent problem, appearing in 20-30% of patients with stroke and in 13-20% of patients with moderate-severe traumatic brain injury. The main objective of this study was to perform a systematic review of the treatments used in spasticity in adult patients with acquired brain damage secondary to stroke and head trauma. A systematic search of randomised controlled trials, published between January 1, 2013 and June 30, 2017 in English and Spanish, was carried out in the PubMed, Cochrane plus Library and Ovid databases. We finally selected 17 studies, with methodological quality that was at least acceptable according to the Jadad scale. The most frequently investigated treatments are botulinum toxin, especially serotype A, together with rehabilitative measures. Clinical scales are the most frequently used to assess spasticity

Secuelas del daño cerebral adquirido, estudio sobre las necesidades terapéuticas / Sequelae of acquired brain damage, study of therapeutic needs

Objetivos: conocer la etiología más común del daño cerebral adquirido, calcular el porcentaje de pacientes que necesitan neurorrehabilitación y examinar la sintomatología relacionada con el área de logopedia, permitiendo justificar la importancia de este profesional en el ámbito de la rehabilitación neurológica. Pacientes y método: en este estudio se realizó un análisis de los pacientes con alteraciones neurológicas ingresados en un hospital de media estancia, entre el 1 de enero de 2011 y el 1 de enero del 2017. Todos los pacientes eran mayores de 18 años, de ambos sexos, con daño cerebral adquirido. La muestra fue obtenida a través del software de gestión asistencial del Centro Hospitalario Benito Menni de Valladolid, seleccionando las unidades dedicadas a la rehabilitación: convalecencia y daño cerebral, leyendo cada historia para conocer las secuelas y la rehabilitación recibida. Resultados: del total de pacientes ingresados en este periodo 480 presentaban alteraciones neurológicas, de los cuales 39 fallecieron antes de recibir rehabilitación por su grave estado, y 10 empeoraron debiendo cesar las terapias. Finalmente, un 89.7% recibieron rehabilitación, presentando trastornos motores relacionados con los miembros superiores e inferiores en un 90.8%, un 39.8% problemas deglutorios y las alteraciones de la comunicación en un 39.6% de la muestra. La etiología del problema neurológico más común, con un 56.5%, fue el ictus isquémico, seguido del hemorrágico en un 16.9% de los casos y de los traumatismos craneoencefálicos en un 15.6%. Conclusión: la etiología más relevante dentro de un centro de media estancia es el ictus isquémico. Las secuelas más significativas son los trastornos motores, seguidos de los problemas deglutorios y de comunicación. El logopeda es un profesional destacado en la rehabilitación del paciente neurológico, debido a los porcentajes y relevancia de los síntomas tratados desde esta área. Es necesario establecer un método de evaluación de los pacientes con daño cerebral, fiable, estandarizado y validado

Objectives: to know the most common etiology of acquired brain damage, calculate the percentage of patients who need neurorehabilitation and examine the symptoms related to the area of speech therapy allowing to justify the importance of this professional in the field of neurological rehabilitation. Patients and method: in this study, an analysis of the patients with neurological alterations admitted to a half-stay hospital was carried out between January 1, 2011 and January 1, 2017. All patients were over 18 years old, of both sexes, with acquired brain damage. The sample was obtained through the care management software of the Centro Hospitalario Benito Menni in Valladolid, selecting the units active in rehabilitation: convalescence and brain damage, reading each story to know the sequelae and the rehabilitation received. Results: of the total number of patients admitted in this period, 480 presented neurological alterations, of which 39 patients died before receiving rehabilitation due to their serious condition, and 10 patients worsened due to the cessation of therapies. Finally, 89.7% received rehabilitation, presenting motor disorders related to the upper and lower limbs in 90.8%, 39.8% swallowing problems and communication alterations in 39.6% of the sample. The etiology of the most common neurological problem with 56.5% was ischemic stroke, followed by hemorrhagic in 16.9% of the cases and traumatic brain injuries in 15.6%. Conclusion: ischemic stroke is the most relevant etiology within a half-stay center. The most significant sequelae are motor disorders, followed by swallowing and communication problems. The speech therapist is a prominent professional in the rehabilitation of the neurological patient, due to the percentages and relevance of the symptoms treated in this area. It is necessary to establish a method of evaluating patients with brain damage, reliable, standardized and validated

Causas y efectos del daño cerebral adquirido traumático y no traumático en una cohorte de 736 pacientes / Causes and effects of traumatic and non-traumatic acquired brain damage in a cohort of 736 patients

Antecedentes: el daño cerebral adquirido es un importante problema de salud pública y la principal causa de muerte y discapacidad, la cual abarca no solo aspectos motrices, sino también del lenguaje, habla, memoria y/o habilidades cognitivas que afectan de manera sustancial la vida de quienes la padecen. Objetivo: analizar y describir causas y efectos del daño cerebral adquirido traumático y no traumático. Material y métodos: estudio analítico transversal retrospectivo; se seleccionaron expedientes de pacientes (2011 a 2015) conformando un total de 736. Se calcularon medias, desviaciones estándar, porcentajes y frecuencias; con la finalidad de evaluar si existía diferencia significativa entre variables se calculó χ2 y dependencia estadística mediante análisis de probabilidad condicional. Resultados: el daño cerebral de origen traumático se presentó en 169 (22.9%) pacientes (138 hombres y 31 mujeres). Las causas principales fueron accidentes automovilísticos (27.8%) y caídas (24.8%); 567 (77%) pacientes (286 hombres, 281 mujeres) presentaron daño por etiología no traumática, principalmente por evento vascular isquémico (377 pacientes, 51.22%). Los diagnósticos establecidos con mayor frecuencia fueron los trastornos del lenguaje y de memoria. Conclusiones: la enfermedad vascular cerebral se está convirtiendo en un problema de salud, por lo que es necesario generar campañas preventivas e informativas sobre la adecuada atención y tratamiento con la finalidad de disminuir la incidencia y la gravedad de la discapacidad de los pacientes afectados

Background: acquired brain damage is a major public health problem and the main cause of death and disability, which encompasses not only motor aspects, but also language, speech, memory and/or cognitive abilities that substantially affect the lives of those suffering from them. Objective: to analyze and describe causes and effects of traumatic and non-traumatic acquired brain damage. Materials and methods: this is a retrospective cross-sectional analytical review. Patient files were selected (2011 to 2015), making a total of 736. Means, standard deviations, percentages and frequencies were calculated; with the purpose of evaluating if there was a significant difference between variables was calculated and statistical dependence through conditional probability analysis. Results: acquired brain injury of traumatic origin occurred in 169 (22.9%) patients (138 men and 31 women). The main causes were car accidents (27.8%) and falls (24.8%); 567 (77%) patients (286 men and 281 women) presented damage due to non-traumatic etiology, mainly due to ischemic vascular event (377 patients, 51.22%). The most commonly established diagnoses were language and memory disorders. Conclusions: cerebral vascular disease is becoming a health problem, so it is necessary to create preventive and informative campaigns about the adequate care and treatment in order to reduce the incidence and severity of the disability of affected patients

Relación entre búsqueda de sensaciones y la toma de decisiones pacientes con daño cerebral adquirido / Relation of sensation seeking and decision making in patients with acquired brain injury

Resumen En este trabajo se evaluó la influencia de la variable cognitiva "búsqueda de sensaciones" en la toma de decisiones en 73 pacientes con daño cerebral adquirido (DCA) a través de un estudio no experimental, transversal y correlacional, mediante la utilización de la Balloon Analogue Risk Task (BART) y la sub escala de búsqueda de sensaciones de la UPPS-P Como grupo control, se aplicaron las pruebas a 30 personas que cumplían con los criterios de inclusión y exclusión propuestos. Se utilizó la BART ya que permite una aplicación más rápida y ofrece una tarea de fácil ejecución y comprensión, que a diferencia de otros instrumentos no requiriere que la persona evaluada presente una capacidad de comprensión verbal compleja bien preservada. Además no existen estudios anteriores que correlacionen ambas pruebas. Como resultado se obtuvieron diferencias significativas entre el grupo clínico y el grupo control donde éste último mostró un nivel mayor de toma de riesgo en la BART y búsqueda de sensaciones en la sub escala UPPS-P. Tomando en cuenta la literatura revisada, los resultados obtenidos y la observación cualitativa del grupo clínico, podríamos sospechar que en la toma de decisionesse halla presente el componente de apatía, y motivación, pudiendo concluir que la búsqueda de sensaciones correlaciona positivamente con el desempeño y elaboración de la toma de decisiones.

Abstract In this paper was evaluated the influence of cognitive variable "sensation-seeking" in decision-making in 73 patients with acquired brain injury (ABI), by means of a non-experimental, cross-sectional and correlational study, through the Balloon Analogue Risk Task (BART) and sensation seeking sub scale of UPPS-P, as control group, test were applied to 30 healthy subjects who met the inclusion and exclusion criteria proposed. The BART is used because allows a faster application and offer a task of easy execution and understanding, unlike others instruments didn't require that evaluated person present a good preserved complex verbal comprehension capability. In addition, there not exist previous studies correlating both tests. As result significant differences between the clinical and the control group where the last one showed a higher level of risk taking in the BART and sensation seeking in the sub scale UPPS-P. Considering the literature reviewed the results and qualitative observation of clinical group. We might suspect that in decision-making is present the apathy and motivation component. Being able to conclude that sensation-seeking correlate positively with elaboration and performance of decision-making.