Programa clínico de telerrehabilitación cognitiva en el traumatismo craneoencefálico / Clinical program of cognitive telerrehabilitation for traumatic brain injury

Objetivo: Validar clínicamente los servicios de rehabilitación cognitiva a través de sistemas de telemedicina (plataforma PREVIRNEC) en personas con traumatismo craneoencefálico (TCE) moderado o grave. Pacientes y Métodos: Ochenta pacientes con TCE moderado o grave; edad media: 36 años (DE=18,19 años); puntuación media en la Glasgow Coma Scale: 6,8 (DE= 3,6). La duración del tratamiento rehabilitador fue 50 sesiones durante 10 semanas. Se valoró la posible mejora cognitiva mediante las diferencias entre las puntuaciones en la exploración neuropsicológica pre y post-tratamiento. Tras finalizar el tratamiento se evaluó la competencia cotidiana del paciente con el Patient Competency Rating Scale (PCRS). Resultados: En función de las puntuaciones en el PCRS los pacientes fueron divididos en dos grupos (grupo pacientes con competencia cotidiana adecuada y grupo pacientes sin competencia cotidiana adecuada). Se observaron diferencias significativas entre ambos grupos en el número de tareas para la rehabilitación de la atención y funciones ejecutivas realizadas con un porcentaje de aciertos elevado (p=0,026 y p=0,040, respectivamente). Conclusiones: El programa de rehabilitación cognitiva basado en sistemas de telemedicina (plataforma PREVIRNEC) mejoró las funciones cognitivas tratadas (atención, memoria y funciones ejecutivas) y el nivel de competencia cotidiana de los pacientes (AU)

Objetive: The purpose of this study was to validate clinically the cognitive rehabilitation services based on telemedicine systems (PREVIRNEC platform) for persons with moderate or severe traumatic brain injury (TBI). Patients and Methods. Eighty patients with moderate or severe TBI; mean age: 36 years; the mean Glasgow Coma Scale score at injury was 6,8 (SD= 3,6). Cognitive rehabilitation took place in 50 sessions during 10 weeks. Differences between pre- and post-treatment neuropsychological test scores were used to measure patient’s improvements in the domains of attention, memory and executive functions. Patient’s everyday competence after rehabilitation was examined with the Patient Competency Rating Scale (PCRS). Results. Patients were divided in two group based in PCRS scores (patients with and without adequate everyday competence). There was observed a significant difference between both groups on number of task performed on higher rang of right responses in attention and executive rehabilitation tasks (p=0,026 and p=0,040, respectively). Conclusions. The cognitive rehabilitation program based on telemedicine systems (PREVIRNEC platform) improves attention, memory, and executive functions and the patient’s everyday competence (AU)

Nutritional supplements used in weight-reduction programs increase intestinal gas in persons who malabsorb lactose.

OBJECTIVE: To determine if ingestion of 2 doses of milk-based dietary supplements produce gaseous symptoms in subjects who malabsorb lactose. DESIGN: Randomized, controlled, crossover trial. SUBJECTS/SETTING: Ten community-based subjects who malabsorb lactose. INTERVENTION: Ingestion of 2 standard servings of milk-based supplements (a powder reconstituted in fat-free milk or a ready-to-drink preparation) or low-lactose control preparations. MAIN OUTCOME MEASURES: Frequency of flatus passage and subjective impression of bloating, flatulence, and abdominal discomfort. STATISTICAL ANALYSIS: Wilcoxon signed-rank test. RESULTS: The high lactose content (27 g) of 2 servings of the powder-based supplement ingested without other food resulted in a marked increase in daily flatus passages from the basal level of 9.7+/-8.2 to 30+/-14 (mean+/-SD), and a significant increase in the subjects' perception of gas. In contrast, the lower lactose content (18.4 g) of 2 servings of a ready-to-drink supplement resulted in a flatus frequency of 17+/-10 (P=.14 vs baseline) and no significant increase in the perception of increased gas. Neither supplement resulted in a significant increase in bloating, abdominal pain, or diarrhea. The lactose content of the liquid supplement was reduced by 80% following overnight incubation with an over-the-counter lactase preparation. APPLICATIONS/CONCLUSIONS: Persons who malabsorb lactose should be aware that sizable increases in rectal gas commonly occur when milk-based powders reconstituted in milk are used as meal replacements. In contrast, gas problems probably will be minor following ingestion of 2 doses of a ready-to-drink, milk-based supplement. The lactose content of these supplements can be markedly reduced by overnight incubation with over-the-counter lactase preparations, and this manipulation should be beneficial for subjects troubled by the increased gas caused by the consumption of lactose-containing supplements.

Absence of gaseous symptoms during ingestion of commercial fibre preparations.

BACKGROUND: While fibre is believed to cause gaseous symptoms, a study in healthy volunteers showed no increase in flatulence when the diet was supplemented with fermentable (psyllium) or non-fermentable (methylcellulose) fibre. However, extrapolation of this observation to subjects who use fibre is arguable since these individuals may have a propensity to gaseousness. In the present study, gaseous complaints during fibre ingestion were assessed in subjects who believed that a previous exposure to fibre induced gas. METHODS: In a double-blind protocol, subjects were randomized to one of four treatment periods, during which the regular diet was supplemented for 1-week periods with two daily doses of: placebo 10 g, psyllium 3.4 g, methylcellulose 2 g or lactulose 5 g. A symptom diary was maintained for 1-week periods on or off treatment. RESULTS: During treatment, the lactulose group passed gas significantly more often than did the psyllium or the methylcellulose group (P = 0.01). No other symptom was significantly different among the treatment groups. CONCLUSIONS: (1) psyllium and methylcellulose did not cause greater gaseous symptomatology than did placebo in subjects who believed that these preparations caused gas; and (2) subjects commonly misidentify dietary components that cause gaseous symptoms.