Toward Personalized Web-Based Cognitive Rehabilitation for Patients With Ischemic Stroke: Elo Rating Approach.

BACKGROUND: Stroke is a worldwide cause of disability; 40% of stroke survivors sustain cognitive impairments, most of them following inpatient rehabilitation at specialized clinical centers. Web-based cognitive rehabilitation tasks are extensively used in clinical settings. The impact of task execution depends on the ratio between the skills of the treated patient and the challenges imposed by the task itself. Thus, treatment personalization requires a trade-off between patients' skills and task difficulties, which is still an open issue. In this study, we propose Elo ratings to support clinicians in tasks assignations and representing patients' skills to optimize rehabilitation outcomes. OBJECTIVE: This study aims to stratify patients with ischemic stroke at an early stage of rehabilitation into three levels according to their Elo rating; to show the relationships between the Elo rating levels, task difficulty levels, and rehabilitation outcomes; and to determine if the Elo rating obtained at early stages of rehabilitation is a significant predictor of rehabilitation outcomes. METHODS: The PlayerRatings R library was used to obtain the Elo rating for each patient. Working memory was assessed using the DIGITS subtest of the Barcelona test, and the Rey Auditory Verbal Memory Test (RAVLT) was used to assess verbal memory. Three subtests of RAVLT were used: RAVLT learning (RAVLT075), free-recall memory (RAVLT015), and recognition (RAVLT015R). Memory predictors were identified using forward stepwise selection to add covariates to the models, which were evaluated by assessing discrimination using the area under the receiver operating characteristic curve (AUC) for logistic regressions and adjusted R2 for linear regressions. RESULTS: Three Elo levels (low, middle, and high) with the same number of patients (n=96) in each Elo group were obtained using the 50 initial task executions (from a total of 38,177) for N=288 adult patients consecutively admitted for inpatient rehabilitation in a clinical setting. The mid-Elo level showed the highest proportions of patients that improved in all four memory items: 56% (54/96) of them improved in DIGITS, 67% (64/96) in RAVLT075, 58% (56/96) in RAVLT015, and 53% (51/96) in RAVLT015R (P<.001). The proportions of patients from the mid-Elo level that performed tasks at difficulty levels 1, 2, and 3 were 32.1% (3997/12,449), 31.% (3997/12,449), and 36.9% (4595/12,449), respectively (P<.001), showing the highest match between skills (represented by Elo level) and task difficulties, considering the set of 38,177 task executions. Elo ratings were significant predictors in three of the four models and quasi-significant in the fourth. When predicting RAVLT075 and DIGITS at discharge, we obtained R2=0.54 and 0.43, respectively; meanwhile, we obtained AUC=0.73 (95% CI 0.64-0.82) and AUC=0.81 (95% CI 0.72-0.89) in RAVLT075 and DIGITS improvement predictions, respectively. CONCLUSIONS: Elo ratings can support clinicians in early rehabilitation stages in identifying cognitive profiles to be used for assigning task difficulty levels.

Discovering the Context of People With Disabilities: Semantic Categorization Test and Environmental Factors Mapping of Word Embeddings from Reddit.

BACKGROUND: The World Health Organization's International Classification of Functioning Disability and Health (ICF) conceptualizes disability not solely as a problem that resides in the individual, but as a health experience that occurs in a context. Word embeddings build on the idea that words that occur in similar contexts tend to have similar meanings. In spite of both sharing "context" as a key component, word embeddings have been scarcely applied in disability. In this work, we propose social media (particularly, Reddit) to link them. OBJECTIVE: The objective of our study is to train a model for generating word associations using a small dataset (a subreddit on disability) able to retrieve meaningful content. This content will be formally validated and applied to the discovery of related terms in the corpus of the disability subreddit that represent the physical, social, and attitudinal environment (as defined by a formal framework like the ICF) of people with disabilities. METHODS: Reddit data were collected from pushshift.io with the pushshiftr R package as a wrapper. A word2vec model was trained with the wordVectors R package using the disability subreddit comments, and a preliminary validation was performed using a subset of Mikolov analogies. We used Van Overschelde's updated and expanded version of the Battig and Montague norms to perform a semantic categories test. Silhouette coefficients were calculated using cosine distance from the wordVectors R package. For each of the 5 ICF environmental factors (EF), we selected representative subcategories addressing different aspects of daily living (ADLs); then, for each subcategory, we identified specific terms extracted from their formal ICF definition and ran the word2vec model to generate their nearest semantic terms, validating the obtained nearest semantic terms using public evidence. Finally, we applied the model to a specific subcategory of an EF involved in a relevant use case in the field of rehabilitation. RESULTS: We analyzed 96,314 comments posted between February 2009 and December 2019, by 10,411 Redditors. We trained word2vec and identified more than 30 analogies (eg, breakfast - 8 am + 8 pm = dinner). The semantic categorization test showed promising results over 60 categories; for example, s(A relative)=0.562, s(A sport)=0.475 provided remarkable explanations for low s values. We mapped the representative subcategories of all EF chapters and obtained the closest terms for each, which we confirmed with publications. This allowed immediate access (≤ 2 seconds) to the terms related to ADLs, ranging from apps "to know accessibility before you go" to adapted sports (boccia). For example, for the support and relationships EF subcategory, the closest term discovered by our model was "resilience," recently regarded as a key feature of rehabilitation, not yet having one unified definition. Our model discovered 10 closest terms, which we validated with publications, contributing to the "resilience" definition. CONCLUSIONS: This study opens up interesting opportunities for the exploration and discovery of the use of a word2vec model that has been trained with a small disability dataset, leading to immediate, accurate, and often unknown (for authors, in many cases) terms related to ADLs within the ICF framework.

Intensidades en la aplicación de tecnologías robóticas en la rehabilitación de las extremidades superiores tras un ictus: revisión sistemática de ensayos clínicos controlados aleatorizados / Intensities in the application of robotic technologies in upper extremity rehabilitation after a stroke: a systematic review of randomised controlled clinical trials

INTRODUCCIÓN: El ictus conlleva limitaciones a largo plazo en el uso de las extremidades superiores afectadas en la gran mayoría de los casos. Las tecnologías robóticas aportan resultados beneficiosos en rehabilitación motora, pero se desconocen los niveles óptimos de intensidad. OBJETIVOS: Revisar la literatura científica (últimos diez años) sobre terapias robóticas (grupo de intervención) en comparación con las terapias convencionales (grupo control) en la fase crónica del ictus y estudiar correlaciones entre las variables que caracterizan a las intervenciones y las variables de intensidad. Sujetos y métodos. Se realizó una revisión sistemática de ensayos clínicos controlados aleatorizados en PubMed, Web of Science, Cochrane Library y Google Scholar, con resultados valorados mediante la Fugl-Meyer Assessment-Upper Extremity Motor Score (mFMA-UE). La calidad metodológica se analizó mediante la escala Physiotherapy Evidence Database (PEDro). RESULTADOS: Se seleccionaron 13 estudios, de nivel de evidencia I (92% excelente). Se observan correlaciones positivas entre los minutos semanales y las mejoras en la mFMA-UE en el grupo control y el grupo de intervención, con mayor nivel de significación para este último. Se observan correlaciones negativas entre el número de meses desde la lesión y las mejoras en el grupo control y en el grupo de intervención. Se incluye una regresión exponencial, que ilustra diferencias entre el grupo control y el grupo de intervención en favor de éste. Se observa una correlación negativa entre la duración total y la cantidad de minutos semanales. CONCLUSIÓN: Se observan correlaciones significativas entre la intensidad (minutos semanales) y la mFMA-UE, con un mayor nivel de significación en el grupo de intervención

INTRODUCTION. In the vast majority of cases stroke entails long-term limitations in the use of the upper extremities that are affected. Robotic technologies provide beneficial results in motor rehabilitation, but the optimal levels of intensity are not known. AIMS. To review the scientific literature (over the last 10 years) on robotic therapies (intervention group) compared to conventional therapies (control group) in the chronic phase of stroke, and to study correlations between variables that characterise the interventions and intensity variables. SUBJECTS AND METHODS. A systematic review was conducted of randomised controlled clinical trials in PubMed, Web of Science, Cochrane Library and Google Scholar, with results assessed by the Fugl-Meyer Assessment-Upper Extremity Motor Score (mFMA-UE). The methodological quality was analysed using the Physiotherapy Evidence Database scale (PEDro). RESULTS. Thirteen studies from evidence level I (92%, excellent) were selected. Positive correlations between minutes per week and improvements in mFMA-UE are observed in the control group and in the intervention group, with a higher level of significance for the latter. Negative correlations are observed between the number of months since the lesion and improvements in the control and intervention groups. An exponential regression is included, which illustrates differences between the control group and the intervention group in favour of the latter. A negative correlation is observed between the total duration and the number of minutes per week. CONCLUSION. Significant correlations are observed between intensity (minutes per week) and mFMA-UE, with a higher level of significance in the intervention group

Stroke Survivors on Twitter: Sentiment and Topic Analysis From a Gender Perspective.

BACKGROUND: Stroke is the worldwide leading cause of long-term disabilities. Women experience more activity limitations, worse health-related quality of life, and more poststroke depression than men. Twitter is increasingly used by individuals to broadcast their day-to-day happenings, providing unobtrusive access to samples of spontaneously expressed opinions on all types of topics and emotions. OBJECTIVE: This study aimed to consider the raw frequencies of words in the collection of tweets posted by a sample of stroke survivors and to compare the posts by gender of the survivor for 8 basic emotions (anger, fear, anticipation, surprise, joy, sadness, trust and disgust); determine the proportion of each emotion in the collection of tweets and statistically compare each of them by gender of the survivor; extract the main topics (represented as sets of words) that occur in the collection of tweets, relative to each gender; and assign happiness scores to tweets and topics (using a well-established tool) and compare them by gender of the survivor. METHODS: We performed sentiment analysis based on a state-of-the-art lexicon (National Research Council) with syuzhet R package. The emotion scores for men and women were first subjected to an F-test and then to a Wilcoxon rank sum test. We extended the emotional analysis, assigning happiness scores with the hedonometer (a tool specifically designed considering Twitter inputs). We calculated daily happiness average scores for all tweets. We created a term map for an exploratory clustering analysis using VosViewer software. We performed structural topic modelling with stm R package, allowing us to identify main topics by gender. We assigned happiness scores to all the words defining the main identified topics and compared them by gender. RESULTS: We analyzed 800,424 tweets posted from August 1, 2007 to December 1, 2018, by 479 stroke survivors: Women (n=244) posted 396,898 tweets, and men (n=235) posted 403,526 tweets. The stroke survivor condition and gender as well as membership in at least 3 stroke-specific Twitter lists of active users were manually verified for all 479 participants. Their total number of tweets since 2007 was 5,257,433; therefore, we analyzed the most recent 15.2% of all their tweets. Positive emotions (anticipation, trust, and joy) were significantly higher (P<.001) in women, while negative emotions (disgust, fear, and sadness) were significantly higher (P<.001) in men in the analysis of raw frequencies and proportion of emotions. Happiness mean scores throughout the considered period show higher levels of happiness in women. We calculated the top 20 topics (with percentages and CIs) more likely addressed by gender and found that women's topics show higher levels of happiness scores. CONCLUSIONS: We applied two different approaches-the Plutchik model and hedonometer tool-to a sample of stroke survivors' tweets. We conclude that women express positive emotions and happiness much more than men.

Occupational performance and multisensory stimulation during post-traumatic amnesia: An observational and randomized controlled trial protocol.

BACKGROUND.: Occupational performance (OP) and interventions during post-traumatic amnesia (PTA) following traumatic brain injury are poorly understood. PURPOSE.: This study aims to describe a study protocol to (a) track person factors of OP throughout PTA and (b) assess the feasibility of a randomized controlled trial (RCT) protocol comparing an occupation-based multisensory stimulation and environmental enrichment intervention with usual care during PTA. METHOD.: A prospective observational study will be conducted with an embedded Phase II RCT with 30 participants in PTA. Participants will be randomly assigned to group and regularly assessed on PTA and OP measures. Feasibility aspects will be recorded in a logbook. All measures will be repeated at PTA resolution and 1 month later, with a follow-up questionnaire completed at 6 months postinjury. FINDINGS.: Observational data will be analyzed using correlations. Feasibility will be examined descriptively, and group comparisons will be conducted to determine effect size. IMPLICATIONS.: Results will provide a broader understanding of OP during PTA and inform future trials.

Consumo de alcohol y tóxicos en pacientes con traumatismo craneoencefálico: repercusión neuroconductual y sobrecarga del cuidador / Alcohol and drug use disorders in patients with traumatic brain injury: neurobehavioral consequences

Objetivos. Describir la frecuencia de consumo de alcohol y tóxicos en pacientes con traumatismo craneoencefálico (TCE) y valorar su relación con los trastornos neuropsiquiátricos, la funcionalidad y la sobrecarga del cuidador. Pacientes y métodos. Se valoraron 156 pacientes con historia de TCE moderado y grave. Se determinó el consumo previo de alcohol y tóxicos. A los informantes de los pacientes se les administró el inventario neuropsiquiátrico (NPI) y la escala de sobrecarga del cuidador de Zarit. La funcionalidad de los pacientes se valoró mediante la escala de puntuación de discapacidad (DRS) y la escala de coma de Glasgow extendida (GOSE). Resultados. Treinta y seis pacientes (23%) eran consumidores habituales de alcohol y otros tóxicos antes del traumatismo. Las alteraciones neuropsiquiátricas fueron más frecuentes y graves en el grupo de consumidores habituales, en especial la irritabilidad y la agitación-agresividad. Sus cuidadores percibieron una sobrecarga mayor. Después del TCE, 16 pacientes (44,4%) recayeron en el consumo. Tener una edad superior y vivir en pareja se asociaron a una mayor tasa de abstinencia. Conclusión. El antecedente de consumo de alcohol y tóxicos es frecuente en pacientes que han sufrido TCE y constituye un factor de riesgo para el desarrollo de alteraciones conductuales. Se necesitan intervenciones más activas encaminadas a la detección de estos casos y a la prevención de recaídas tras el traumatismo (AU)

Aims. To describe the prevalence of alcohol and drugs use in patients with traumatic brain injury (TBI), and to assess their relationship with neuropsychiatric disorders, functioning and caregiver burden. Patients and methods. 156 patients with a history of moderate and severe TBI were evaluated. The use of alcohol and drugs was determined. The Neuropsychiatric Inventory (NPI) and the Zarit questionnaire were applied to caregivers. The patients functioning were assessed with the Disability Rating Scale (DRS) and Glasgow Outcome Scale Extended (GOSE). Results. 36 patients (23%) were regular users of alcohol and other drugs before the TBI. Neuropsychiatric disorders were more frequent and severe in this group, especially irritability and agitation-aggressiveness. Their caregivers perceived a higher burden. After TBI, 16 patients (44.4%) relapsed in alcohol-drugs consumption. Having a higher age and living with a partner were associated with higher rates of abstinence. Conclusion. The history of alcohol and drugs abuse is common in patients with TBI and it is a risk factor for development of behavioral disorders. More active interventions are needed aimed to detect these cases and work for prevention of relapse after trauma (AU)

[Alcohol and drug use disorders in patients with traumatic brain injury: neurobehavioral consequences and caregiver burden]. / Consumo de alcohol y tóxicos en pacientes con traumatismo craneoencefálico: repercusión neuroconductual y sobrecarga del cuidador

AIMS: To describe the prevalence of alcohol and drugs use in patients with traumatic brain injury (TBI), and to assess their relationship with neuropsychiatric disorders, functioning and caregiver burden. PATIENTS AND METHODS: 156 patients with a history of moderate and severe TBI were evaluated. The use of alcohol and drugs was determined. The Neuropsychiatric Inventory (NPI) and the Zarit questionnaire were applied to caregivers. The patients functioning were assessed with the Disability Rating Scale (DRS) and Glasgow Outcome Scale Extended (GOSE). RESULTS: 36 patients (23%) were regular users of alcohol and other drugs before the TBI. Neuropsychiatric disorders were more frequent and severe in this group, especially irritability and agitation-aggressiveness. Their caregivers perceived a higher burden. After TBI, 16 patients (44.4%) relapsed in alcohol-drugs consumption. Having a higher age and living with a partner were associated with higher rates of abstinence. CONCLUSION: The history of alcohol and drugs abuse is common in patients with TBI and it is a risk factor for development of behavioral disorders. More active interventions are needed aimed to detect these cases and work for prevention of relapse after trauma.

Manifestaciones neurológicas y su impacto funcional en sujetos que han padecido un golpe de calor / Neurological manifestations and their functional impact in subjects who have suffered heatstroke

Introducción. El golpe de calor es una emergencia médica, potencialmente mortal, caracterizada por un incremento en la temperatura corporal por encima de 40 °C, que se acompaña de una afectación del sistema nervioso central secundaria a un fallo en el sistema termorregulador. De no intervenirse oportunamente, las consecuencias pueden ser fatales, produciéndose la muerte, pero también puede conllevar secuelas neurológicas permanentes y discapacitantes con afectación en la calidad de vida del individuo. Casos clínicos. Tras una búsqueda retrospectiva de los pacientes ingresados en una unidad de rehabilitación de daño cerebral con el diagnóstico de golpe de calor, presentamos a cinco sujetos. El espectro clínico comprendía una debilidad motora con una grave afectación de la coordinación y el equilibrio con ataxia y disartria, que estaban acompañados de una mayor o menor afectación cognitiva. Todos los pacientes eran dependientes para las actividades básicas de la vida diaria tanto antes como después del tratamiento rehabilitador. Conclusiones. La mejoría funcional de los cinco sujetos tras la realización de la rehabilitación fue nula, lo que les condicionó una dependencia total de terceras personas. Por ello, es primordial una prevención ante olas de calor, una actuación médica inmediata y, finalmente, una vez instaurado el cuadro, los esfuerzos rehabilitadores se han de encaminar a evitar complicaciones. En esta tesitura, es importante la existencia de programas sociales de apoyo a las familias y a los pacientes (AU)

Introduction. Heatstroke is a potentially fatal medical emergency characterised by an increase in body temperature above 40 °C and which is accompanied by negative effects on the central nervous system secondary to failure of the thermoregulatory system. If timely care is not provided, the consequences can be fatal and the patient dies, but they can also ¡result in permanent disabling neurological sequelae that compromise the individual’s quality of life. Case reports. Following a retrospective search on patients diagnosed with heatstroke who were admitted to a brain damage rehabilitation unit, we report the cases of five subjects. The clinical spectrum ranged from motor weakness with severely compromised coordination and balance with ataxia and dysarthria, which were accompanied by cognitive impairment of varying degrees of severity. All the patients required help in performing their basic activities of daily living both before and after treatment with rehabilitation. Conclusions. No functional improvement was observed in the five subjects after completing rehabilitation, which left them wholly dependent on some caregiver. It is therefore essential to prevent heatstroke, provide immediate medical care and, finally, once the clinical signs and symptoms have set in, rehabilitation treatment must be focused on preventing the appearance of complications. In such a situation the existence of social support for relatives and for patients plays a crucial role (AU)

[Neurological manifestations and their functional impact in subjects who have suffered heatstroke]. / Manifestaciones neurologicas y su impacto funcional en sujetos que han padecido un golpe de calor.

INTRODUCTION: Heatstroke is a potentially fatal medical emergency characterised by an increase in body temperature above 40 °C and which is accompanied by negative effects on the central nervous system secondary to failure of the thermo-regulatory system. If timely care is not provided, the consequences can be fatal and the patient dies, but they can also result in permanent disabling neurological sequelae that compromise the individual's quality of life. CASE REPORTS: Following a retrospective search on patients diagnosed with heatstroke who were admitted to a brain damage rehabilitation unit, we report the cases of five subjects. The clinical spectrum ranged from motor weakness with severely compromised coordination and balance with ataxia and dysarthria, which were accompanied by cognitive impairment of varying degrees of severity. All the patients required help in performing their basic activities of daily living both before and after treatment with rehabilitation. CONCLUSIONS: No functional improvement was observed in the five subjects after completing rehabilitation, which left them wholly dependent on some caregiver. It is therefore essential to prevent heatstroke, provide immediate medical care and, finally, once the clinical signs and symptoms have set in, rehabilitation treatment must be focused on preventing the appearance of complications. In such a situation the existence of social support for relatives and for patients plays a crucial role.

Perfil psicopatológico de pacientes con traumatismo craneoencefálico evaluados mediante el Inventario Neuropsiquiátrico / Psychopatological evaluation of traumatic brain injury patients with the Neuropsychiatric Inventory

Introducción. El Inventario Neuropsiquiátrico (NPI) es una escala que valora la presencia de alteraciones psicopatológicas en pacientes con enfermedades neurológicas, principalmente demencias. A pesar de sus ventajas, existen pocos estudios publicado en pacientes con traumatismo craneoencefálico (TCE). Con la información derivada del NPI pretendemos describir las alteraciones psicopatológicas en un grupo de pacientes con TCE severo en fase crónica y determinar si se correlacionan con antecedentes psiquiátricos y medidas de resultado. Método. Se administró el NPI a los informantes de 53 pacientes con traumatismo craneoencefálico grave que se encontraban en fase crónica. Así mismo, se recogieron escalas de funcionalidad y de integración a la comunidad. Resultados. El 92,5% de la muestra estudiada presentaba alguna alteración psicopatológica según el NPI, siendo los síntomas más frecuentes la irritabilidad/labilidad, la apatía y la depresión/disforia. El antecedente de consumo habitual de tóxicos mostró una relación significativa con la presencia de psicopatología. Síntomas como la agitación, la apatía y la desinhibición se correlacionaron de forma significativa con el grado de discapacidad. Conclusiones. Las alteraciones psiquiátricas son frecuentes en pacientes con TCE. El nNPI es una herramienta que recoge de manera sistemática las alteraciones conductuales y emocionales más frecuentes en estos pacientes. Algunos de los síntomas influyen negativamente en el grado de discapacidad(AU)

Introduction. The Neuropsychiatric Inventory (NPI) is a scale that assesses psychiatric symptoms in patients with neurological disorders, principally dementia. Despite its advantages, there are few published studies in traumatic brain injury (TBI) patients. With the NPI information we are going to describe the psychopatologic disorders in a group of TBI chronic patients and look the possible association with psychiatric history and outcome measures. Method. The NPI was applied to caregivers of 53 patients with severe TBI in chronic phase. We also collected functional and community integration scales. Results. 92.5% of patients had some neuropsychiatric symptom, according to NPI. The most frequents were irritability/lability, apathy and depression/dysphoria. Those patients with drugs abuse history had more psychiatric symptoms. Presence of agitation/aggression, apathy and disinhibition were correlated with more disability. Conclusions. Psychiatric disorders are common between patients with TBI. The NPI is a scale that systematically assesses the behavioral and emotional disorders more common in these patients. Some of the symptoms negatively influence the degree of disability(AU)

[Psychopatological evaluation of traumatic brain injury patients with the Neuropsychiatric Inventory]. / Perfil psicopatológico de pacientes con traumatismo craneoencefálico evaluados mediante el Inventario Neuropsiquiátrico.

INTRODUCTION: The Neuropsychiatric Inventory (NPI) is a scale that assesses psychiatric symptoms in patients with neurological disorders, principally dementia. Despite its advantages, there are few published studies in traumatic brain injury (TBI) patients. With the NPI information we are going to describe the psychopatologic disorders in a group of TBI chronic patients and look the possible association with psychiatric history and outcome measures. METHOD: The NPI was applied to caregivers of 53 patients with severe TBI in chronic phase. We also collected functional and community integration scales. RESULTS: 92.5% of patients had some neuropsychiatric symptom, according to NPI. The most frequents were irritability/lability, apathy and depression/dysphoria. Those patients with drugs abuse history had more psychiatric symptoms. Presence of agitation/aggression, apathy and disinhibition were correlated with more disability. CONCLUSIONS: Psychiatric disorders are common between patients with TBI. The NPI is a scale that systematically assesses the behavioral and emotional disorders more common in these patients. Some of the symptoms negatively influence the degree of disability.

Cambios en resonancia magnética funcional de la corteza sensitivomotora en pacientes con traumatismo craneoencefálico tras un programa intensivo de rehabilitación / Changes in the functional magnetic resonance imaging of the sensorimotor cortex in traumatic brain injury after intensive rehabilitation

Objetivo. Evaluar el potencial de reorganización de la corteza sensitivomotora en pacientes con traumatismo craneoencefálico (TCE) después de un programa intensivo de rehabilitación. Pacientes y métodos. Se valoraron los cambios en la resonancia magnética funcional (RMf) motora en un paciente de 17 años afecto de TCE grave antes y después de un programa de rehabilitación motora. Las tareas realizadas durante el análisis con RMf fueron: oposición sucesiva del pulgar a los demás dedos de la mano (RMf motora de la mano) y flexión plantar del tobillo y de los dedos (RMf motora del pie), en ambos casos bilateral con períodos de reposo intercalados. Resultados. Previamente al tratamiento, las áreas cerebrales activadas durante la RMf motora de la mano derecha fueron el área motora primaria (M1), el área motora suplementaria (AMS), el área parietal superior y la región poscentral. Para la mano izquierda, las áreas de mayor actividad fueron M1 y cerebelo. Posteriormente al tratamiento, las áreas activadas fueron la región pre y poscentral para la mano derecha y la región precentral para la mano izquierda. Para la función motora del pie, las áreas activadas antes del tratamiento fueron el área paracentral para el pie derecho, y el AMS y el área poscentral para el pie izquierdo. Después del tratamiento, la activación para el pie derecho se vio en el área paracentral, y la activación para el pie izquierdo en el área paracentral y en el AMS. Conclusiones. La disminución de la actividad cortical posterior al tratamiento puede explicarse como una reorganización cortical, que en el presente estudio se correlaciona con los automatismos y habilidades motoras adquiridas por el paciente durante el proceso de rehabilitación (AU)

Aim. To evaluate the potential reorganization of the sensorimotor cortex in a patient with traumatic brain injury after an intensive motor rehabilitation. Patients and methods. A 17-year-old male with severe traumatic brain injury was submitted to functional magnetic resonance imaging (fMRI) analyses of motor control before and after motor rehabilitation. The motor tasks performed during fMRI were finger tapping, ankle plantar flexion, and toe flexion. Results. Prior to treatment, the cerebrally activated areas for the right hand during finger tapping were the primary motor (M1), supplementary motor area (SMA), superior parietal and postcentral areas. For the left hand, the areas were the M1 and the cerebellum. After treatment, the activated areas were the pre and postcentral areas for the right hand and the precentral area for the left hand. For the foot motor-task, the activated areas prior to treatment were the paracentral area for the right foot, and the SMA, paracentral and poscentral areas for the left. After treatment, activation for the right foot was seen in the paracentral area, and activation for the left foot was seen in the paracentral area and SMA. Conclusions. The decrease in the post-treatment activation pattern could be explained as a cortical reorganization, which in the current study was related to motor skill and motor automatism acquired by the patient (AU)

[Changes in the functional magnetic resonance imaging of the sensorimotor cortex in traumatic brain injury after intensive rehabilitation]. / Cambios en resonancia magnética funcional de la corteza sensitivomotora en pacientes con traumatismo craneoencefalico tras un programa intensivo de rehabilitación.

AIM: To evaluate the potential reorganization of the sensorimotor cortex in a patient with traumatic brain injury after an intensive motor rehabilitation. PATIENTS AND METHODS: A 17-year-old male with severe traumatic brain injury was submitted to functional magnetic resonance imaging (fMRI) analyses of motor control before and after motor rehabilitation. The motor tasks performed during fMRI were finger tapping, ankle plantar flexion, and toe flexion. RESULTS: Prior to treatment, the cerebrally activated areas for the right hand during finger tapping were the primary motor (M1), supplementary motor area (SMA), superior parietal and postcentral areas. For the left hand, the areas were the M1 and the cerebellum. After treatment, the activated areas were the pre and postcentral areas for the right hand and the precentral area for the left hand. For the foot motor-task, the activated areas prior to treatment were the paracentral area for the right foot, and the SMA, paracentral and poscentral areas for the left. After treatment, activation for the right foot was seen in the paracentral area, and activation for the left foot was seen in the paracentral area and SMA. CONCLUSIONS: The decrease in the post-treatment activation pattern could be explained as a cortical reorganization, which in the current study was related to motor skill and motor automatism acquired by the patient.

[Traumatic brain injury and daily life: The role of executive function]. / Traumatismo craneoencefálico y vida cotidiana: el papel de las funciones ejecutivas.

Executive functions are critical in our daily life. People with traumatic brain injury (TBI) often have difficulty functioning appropriately in everyday life. The objective of this study was to investigate the relationship between executive function and functional capacity after TBI. The sample consisted of 43 moderate or severe TBI patients (mean age: 32 years, SD= 13.9). All participants were tested with a battery of executive function measures (Trail Making Test-B, Wisconsin Card Sorting Test, Letter-Number Sequencing of the WAIS-III, Stroop Color-Word Interference Test, and Controlled Oral Word Association Test). Patients' everyday functioning was examined with the Patient Competency Rating Scale (PCRS). PCRS was correlated significantly, although moderately, with Trail Making Test-B, Letter-Number Sequencing, and Controlled Oral Word Association Test. These findings suggest that executive function measures used in clinical practice reveal some degree of ecological validity, providing relevant information for predicting daily-life functioning after moderate to severe TBI.

Traumatismo craneoencefálico y vida cotidiana: el papel de las funciones ejecutivas / Traumatic brain injury and daily life: The role of executive function

Las funciones ejecutivas son críticas en nuestra vida cotidiana. A menudo las personas que han sufrido un traumatismo craneoencefálico (TCE) tienen dificultades para afrontar adecuadamente su día a día. En este trabajo se ha estudiado la relación entre funciones ejecutivas y capacidad funcional tras un TCE. Han participado 43 pacientes con TCE moderado o grave (edad media: 32 años; DT: 13,9 años). A todos ellos se les ha administrado una batería de test ejecutivos (Trail Making Test-B, Wisconsin Card Sorting Test, Letras y Números del WAIS-III, Test de Stroop y un test de fluencia verbal). El funcionamiento cotidiano ha sido valorado mediante el Patient Competency Rating Scale (PCRS). El PCRS correlaciona significativamente, si bien de forma moderada, con el Trail Making Test-B, Letras y Números y el test de fluencia verbal. Estos hallazgos sugieren que tests ejecutivos empleados habitualmente en la práctica clínica poseen cierto grado de validez ecológica, proporcionando así información relevante para predecir el funcionamiento cotidiano después de un TCE moderado o grave(AU)

Executive functions are critical in our daily life. People with traumatic brain injury (TBI) often have difficulty functioning appropriately in everyday life. The objective of this study was to investigate the relationship between executive function and functional capacity after TBI. The sample consisted of 43 moderate or severe TBI patients (mean age: 32 years, SD= 13.9). All participants were tested with a battery of executive function measures (Trail Making Test-B, Wisconsin Card Sorting Test, Letter-Number Sequencing of the WAIS-III, Stroop Color-Word Interference Test, and Controlled Oral Word Association Test). Patients’ everyday functioning was examined with the Patient Competency Rating Scale (PCRS). PCRS was correlated significantly, although moderately, with Trail Making Test-B, Letter-Number Sequencing, and Controlled Oral Word Association Test. These findings suggest that executive function measures used in clinical practice reveal some degree of ecological validity, providing relevant information for predicting daily-life functioning after moderate to severe TBI(AU)

Tele-rehabilitation: present and future.

SUMMARY: During the last decade we assisted to relevant progress in rehabilitation studies and in technological development. From the combination of these issues rises the tele-rehabilitation--a subfield of telemedicine consisting of a system to control rehabilitation "at distance"--as an actual possibility of application and a promising development in the future. The present paper offers a short review of the state of the art in the field of tele-rehabilitation, with a special focus on upper limb tele-rehabilitation. The experience is also briefly reported of the preliminary application of the H-CAD (home care activity desk) system and the HELLODOC (Healthcare service linking tele-rehabilitation to disabled people and clinicians) tele-rehabilitation service, conducted by the authors within two European projects in the period 2003-2005 and 2005-2007 respectively.