Avaliação e Reabilitação Neuropsicológica após Lesão Encefálica Adquirida / Evaluación y Rehabilitación Neuropsicológica después de una Lesión Cerebral Adquirida / Neuropsychological Evaluation and Rehabilitation after Acquired Brain Injury

Resumo Sintomas de desconexão inter-hemisférica após lesão cerebral adquirida são pouco usuais na prática clínica atualmente. Os sintomas costumam diminuir espontaneamente e podem incluir anomia táctil, agrafia à esquerda e sinais de competição entre os hemisférios, como o "sinal da mão alienígena". Este trabalho tem por objetivo apresentar um relato de caso clínico de paciente de 33 anos, que evoluiu com sintomas de desconexão inter-hemisférica e alterações de funções executivas, após intervenção cirúrgica para remoção de tumor em região da hipófise, além de avaliar a aplicabilidade de programa de reabilitação neuropsicológica para as queixas cognitivas apresentadas. O paciente foi avaliado com instrumentos neuropsicológicos padronizados antes de iniciar a reabilitação e próximo à alta do tratamento. O estudo de caso foi realizado a partir da análise de dados de intervenção e evolução clínica do paciente em prontuário institucional (resultados de exame de avaliação neuropsicológica e registros de intervenções em sessões de reabilitação). Ao longo de sua evolução, o paciente apresentou melhora dos sintomas cognitivos e demonstrou benefício com os treinos e estratégias utilizados para sua adaptação, bem como para retomar o trabalho e outras atividades prévias. Destaca-se ainda a importância de se realizar mais estudos de intervenções neuropsicológicas para indivíduos com déficits cognitivos.

Resumen Los síntomas de desconexión interhemisférica después de una lesión cerebral adquirida son inusuales en la práctica clínica actual. Los síntomas generalmente disminuyen de forma espontánea y pueden incluir anomia táctil, agrafía izquierda y signos de la competencia entre los hemisférios. Este estudio tiene como objetivo presentar un caso clínico de un paciente de 33 años, que desarrollaron síntomas de desconexión interhemisférica después de la cirugía para la extirpación del tumor en la región pituitaria y alteraciones en la función ejecutiva y evaluar la aplicabilidad del programa de rehabilitación neuropsicológica para las quejas cognitivas. El paciente fue evaluado con instrumentos neuropsicológicas estandarizadas antes de comenzar la rehabilitación y cerca del máximo tratamiento. El estudio de caso se llevó a cabo a partir del análisis de datos de intervención y el desarrollo clínico del paciente registro médico institucional (resultados de los exámenes de evaluación neuropsicológica y las intervenciones en los registros de las sesiones de rehabilitación). A lo largo de su evolución, el paciente mostró una mejoría en los síntomas cognitivos y demostró un beneficio con la formación y las estrategias utilizadas para adaptarse y para reanudar el trabajo y otras actividades anteriores. También pone de relieve la importancia de llevar a cabo más estudios de intervenciones neuropsicológicas para las personas con déficits cognitivos.

Abstract Symptoms of interhemispheric disconnection after acquired brain injury are unusual in the current clinical practice. Symptoms usually diminish spontaneously and may include tactile anomia, agraphia and left signs of competition between the hemispheres, such as "alien hand sign". This work presents a case report of a 33 year old patient who developed symptoms of interhemispheric disconnection and executive function deficits after surgery for removal of a tumor in the pituitary region, as well as the evaluation of the applicability of the neuropsychological rehabilitation program for the cognitive complaints presented. The patient was evaluated with standardized neuropsychological instruments before starting rehabilitation and again close to the discharge from treatment. The case study was conducted by analyzing intervention data and the clinical outcome of the patient in the institutional records (results of neuropsychological evaluation examination and records of interventions in rehabilitation sessions). Throughout his evolution, the patient showed improvement in cognitive symptoms and demonstrated benefits from the training and strategies used for his adaptation and return to work and other previous activities. The study highlights the importance of conducting more studies of neuropsychological interventions for individuals with cognitive deficits.

Prevalence of at-risk drinking among Brazilian truck drivers and its interference on the performance of executive cognitive tasks.

BACKGROUND: Binge drinking (BD) has been associated with an increase in the risk of alcohol-related injuries. Alcohol continues to be the main substance consumed by truck drivers, a population of special concern, since they are often involved in traffic accidents. The aim of this study was to estimate the prevalence of BD and its interference in the executive functioning among truck drivers in Sao Paulo, Brazil. METHODS: A non-probabilistic sample of 684 truck drivers was requested to answer a structured research instrument on their demographic data and alcohol use. They performed cognitive tests to assess their executive functioning and inventories about confounding variables. The participants were then divided according to their involvement in BD. RESULTS: 17.5% of the interviewees have reported being engaged in BD. Binge drinkers showed a better performance on one test, despite having done so at the expense of more mistakes and lower accuracy. More interestingly, binge drinkers took three seconds longer than non-binge drinkers to inhibit an inadequate response, which is worrisome in the context of traffic. Overall, the deleterious effect of BD on performance remained after controlling for the effects of confounding variables in regression logistic models. CONCLUSIONS: As the use of alcohol among truck drivers may be as a way to get by with their work conditions, we believe that a negotiation between their work organization and public authorities would reduce such use, preventing negative interferences on truck drivers' cognitive functioning, which by its turn may also prevent traffic accidents.

Reabilitação neuropsicológica em fase aguda e crônica após Traumatismo Crânio-Encefálico (TCE) grave: relato de caso / Neuropsychological rehabilitation during acute and chronicle stages in severe TBI: Case report

Nos últimos anos, é frequente o debate sobre a complexidade da pesquisa na área de ciências humanas. A psicologia clínica possui algumas particularidades e convoca para o debate, para a busca de novos caminhos e de novas possibilidades metodológicas. Neste artigo, pretende-se discutir as particularidades da pesquisa em psicologia clínica e objetiva-se apresentar como a leitura da obra de Winnicott permite a compreensão da pesquisa como um ato criativo. (AU)

In the last few years, there is a frequent discussion about the complexity of research in human sciences. Clinical psychology has some characteristics that motivate the discussion and search of new ways and new methodological possibilities. In this article, we discuss the details of research in clinical psychology and present how the collected works from Winnicott allows the comprehension of research as a creative act. (AU)

Disorders in planning and strategy application in frontal lobe lesion patients.

The aim of this study was to investigate deficits in planning ability using an adapted version of the Modified Six Elements Test, from the Behavioral Assessment of the Dysexecutive Syndrome-BADS [Wilson, B. A., Alderman, N., Burgess, P. W., Emslie, H., & Evans, J. J. (1996). Behavioural Assessment of the Dysexecutive Syndrome (BADS). Bury St Edmunds, U.K.: Thames Valley Test Company. Trans. Ricardo O Souza, Sergio L Schmidt. Rio de Janeiro: Cognição]. Subjects were left- and right-frontal lobe lesion patients. Other measures of executive dysfunctions used were verbal fluency, the Wisconsin Card Sorting Test, and the Trail Making Test. These other instruments were sensitive to detect executive deficits in the left frontal lobe lesion group, except the Wisconsin Card Sorting Test, which showed impairment only for the frontal lobe lesion group as a whole. The Modified Six Elements Test detected planning disorders in left frontal lobe lesion patients. The deficit of these patients was due to a greater likelihood to break the rules of the task, that is, in plan-following processes, rather than in planning the strategic approach to solve it.