Avances en la investigación y rehabilitación del daño cerebral

Conferencia docente para Logopedia y PsicologíaEn la actualidad, más de 10 millones de personas en el mundo viven con las secuelas producidas por un daño cerebral. Entre los diferentes tipos de daño cerebral los traumatismos craneoencefálicos (TEC) son una de las principales causas de muerte entre personas de 15 a 24 años. La gran mayoría de los TEC suelen estar relacionados con caídas, accidentes automovilísticos y heridas por armas de fuego. Durante las dos últimas décadas se ha incrementado considerablemente el número de personas que sobreviven a un TEC, debido a un mayor conocimiento por parte de los médicos y del personal de los servicios de urgencia acerca de los efectos del trauma; la creación de métodos diagnósticos más avanzados y la comprensión de los mecanismos cerebrales involucrados en la recuperación. No obstante, muchas de las personas que logran sobrevivir a un TEC presentan secuelas a largo plazo tales como alteraciones cognitivas (problemas de memoria, atención, en la velocidad de procesamiento de la información y en funciones ejecutivas), problemas físicos (alteraciones en el movimiento, pérdida del equilibrio, dolores de cabeza, fatiga, alteraciones del sueño, mareos y náuseas) y cambios emocionales (depresión, agitación, agresividad, cambios de personalidad, apatía e irritabilidad). El objetivo de la presente conferencia es exponer, de forma detallada, algunos de los principales avances mas recientes en la investigación del daño cerebral. Inicialmente se comenzara hablando de la definición del TEC, la epidemiología, los principales hallazgos en el área de la neuropsicología, las alteraciones emocionales, los problemas sexuales y su recuperación. Posteriormente se presentaran algunos resultados sobre investigaciones recientes en el área de las neuroimagenes y daño cerebral leve y el papel de la familia en la vida de personas con TEC. Finalmente, se hablara de la importancia del estudio del TEC en población española y de las consecuencias que este problema tiene para la salud pública del país.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

TEORÍA DE LA RETROGÉNESIS EN LA ENFERMEDAD DE ALZHEIMER: EVIDENCIA E IMPLICACIONES CLÍNICAS

Alzheimer’s disease (AD) is a one of the top leading causes of death in the world. In the United States alone, over 4.5 million Americans had Alzheimer’s in the year 2000. The annual number of new cases is increasing dramatically every year as people begin to reach older ages in which the prevalence of AD is higher and as people survive longer with the disease. Anecdotal observations of individuals with AD from family members and/or caregivers indicate how suffers become “childlike” as the disease progresses. Recent research suggests that the progression of AD occurs in reverse order of normal human development. The present article reviews the evidence supporting this theory of retrogenesis. Cognitive, functional, neurologic and neuropathologic progression of AD will be examined and compared to developmental acquisition in each area. Potential implications of the retrogenesis theory on rehabilitation program development and implementation for individuals with dementia will be discussed.La enfermedad de Alzheimer (EA) es una de las principales causas de muerte en el mundo. El bajo índice de natalidad, la mejora en las condiciones sanitarias y sociales y, como consecuencia, el aumento en la esperanza de vida, han hecho que el número de personas mayores de 65 anos aumente cada vez más. Este aumento en la expectativa de vida ha lle-vado a que el número de casos nuevos de personas que presentan EA se haya incrementando de manera dramática en los últimos años. Diferentes estudios han demostrado que conforme va evolucionando la enfermedad de Alzheimer, se suele producir una regresión de las capacidades cognitivas, funcionales y físicas a estadios evolutivos previos del desarrollo. El presente artículo tiene como objetivo realizar una revisión de la evidencia que apoya el concepto de retro-génesis en la Enfermedad de Alzheimer, a la luz de la teoría del desarrollo evolutivo de Piaget. Se examinará la teoría de la retro-génesis tanto desde una perspectiva clínica, cognitiva, funcional, neurológica y neuropatológica. Finalmente, se discutirá las implicaciones que la teoría de la retro-génesis puede tener en la creación e implementación de programa de rehabilitación para personas con demencia

Training on Emotional Intelligence for Caregivers of Patients with Acquired Brain Injury and Cognitive Impairment: A Quasi-Experimental Study

Background: Cognitive-behavioral alterations can occur after an acquired brain injury (ABI). Objectives: To develop and evaluate a synchronous online training program on emotional intelligence (EI) for the caregivers of adult patients with cognitive-behavioral impairment due to ABI. Methods: Quasi-experimental study. Ten caregivers attended a one-month virtual synchronous course about EI. The emotional status of the caregivers was registered one-month-previous and one-month-post program using comparative measures: The Trait Meta-Mood Scale (TMMS-24), the Positive and Negative Affect Schedule (PANAS), Caregiver Burden Interview, the 10-item Connor-Davidson Resilience Scale, and the Emotional Health Survey. Results: After the training course, the favorable changes related to emotional affect measured with the PANAS questionnaire were found; both positive (increase; Mdn = 39.5; effect size −12.79; adjusted variance 95.75) and negative (decrease; Mdn = 14.5; effect size 0.73; adjusted variance 95.50) presented a statistical significance of p < 0.05. The TMMS-24 post-test showed that 90% of the caregivers reported an adequate or excellent emotional repair (p < 0.05; effect size −0.68; adjusted variance 94.75). No other significant differences were found. Conclusions: After this training in EI, the caregivers had a more positive mood and improved aspects of their emotional intelligence, such as emotional regulation. More studies need to be conducted.Partial funding for open access charge: Universidad de Málag

Comparability of (post-concussion) symptoms across time in individuals after traumatic brain injury: results from the CENTER-TBI study

Post-concussion symptoms often occur after TBI, persist and cause disabilities. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used in this population, but little is known about the comparability of the symptoms over time, i.e., longitudinal measurement invariance (MI). The objectives of this study were to analyze the longitudinal MI of RPQ symptoms from three to twelve months after TBI and to find factors related to RPQ symptoms. The study involved 1023 individuals after TBI who took part in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study and completed the RPQ at three, six and twelve months postinjury. Longitudinal confirmatory factor analysis showed that the three-factor structure (somatic, emotional and cognitive) remains stable within one year after TBI. Linear mixed models revealed that sex, injury cause and prior psychiatric problems were related to the RPQ three-factor structure as well as to the RPQ total score. The study strengthens evidence for the RPQ’s factorial structure stability within one year after TBI and identifies sex, injury cause and prior psychiatric problems as important factors that may help clinicians to prevent future complications of symptomatology after TBI.CENTER-TBI was supported by the European Union 7th Framework program (EC grant 602150). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA) and from Integra LifeSciences Corporation (USA). The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report

Is Helping Really Helping? Health-Related Quality of Life after TBI Predicting Caregiver Depression Longitudinally in Latin America

Objective: Studies have shown that functional and psychosocial sequelae of traumatic brain injury (TBI) predict emotional well-being of caregivers (Harris, 2000). Previous research examining the mental health of caregivers and the health-related quality of life (HRQoL) of people with TBI have primarily been in the US (Sander, 2012). Very little research has been conducted to uncover the unique relationships between HRQoL of people with TBI and caregiver mental health longitudinally, or in low-middle income Latin American countries. The aim of this study was to evaluate how HRQoL after TBI predict caregiver depression longitudinally in two countries and three data collection sites in Latin America. Design: Multi-site, multinational longitudinal study. Setting: Three hospitals in Neiva and Cali, Colombia, and Mexico City, Mexico (before hospital discharge), as well as in the homes of individuals with TBI and caregivers in these regions (before discharge, at 2 and 4 months after discharge). Participants: A sample of 109 TBI caregiver-patient dyads (n = 218) was included in the study. Main Outcome Measure(s): Caregiver depression (Patient Health Questionnaire-9) and HRQoL in the person with TBI (Short Form-36). Results: Three multiple regressions were conducted to examine which aspects of patient HRQoL at baseline predicted caregiver depression at baseline, 2 months, and 4 months post-discharge. Eight aspects of patient HRQoL were simultaneously entered into each model as predictors: physical functioning, role limitations (physical and emotional), vitality, mental health, social functioning, pain, and general health. At baseline, the overall model significantly predicted caregiver depression, F(8, 105) = 2.62, p = .012, R 2 = .18. Patient mental health was the only significant unique predictor of caregiver depression at baseline, p = .021, β = -.34. The overall model predicting 2-month caregiver depression was significant, F(8, 101) = 3.21, p = .003, R 2 = .22. Only mental health, p = .016, β = -.36, was a significant unique predictor. The overall model predicting 4-month caregiver depression was significant, F(8, 98) = 2.70, p = .010, R 2 = .19, and no factors uniquely predicted caregiver depression, all ps\u3e.05. Conclusions: Results suggest that TBI patient HRQoL can predict caregiver depression among Latin American caregivers before and during the first 4 months after hospital discharge. Across all three time points (baseline, 2 months, and 4 months), caregiver depression was significantly predicted by patient HRQoL. At baseline, patient mental health was the only domain that uniquely predicted caregiver depression. At 2 months, only physical role limitations uniquely predicted caregiver depression, and no unique predictors were detected at 4 months. These findings suggest that within the cultural framework in Latin America, there is a strong relationship between functional and psychological impairments after TBI and depression outcomes in Latin American caregivers. The results highlight the importance of uncovering these relational distinctions and may infer early detection of mental health needs and psychological intervention considerations for Latin American caregivers.https://scholarscompass.vcu.edu/gradposters/1052/thumbnail.jp

Family Dynamics and Personal Strengths among Dementia Caregivers in Argentina

This study examined whether healthier family dynamics were associated with higher personal strengths of resilience, sense of coherence, and optimism among dementia caregivers in Argentina. Caregivers are usually required to assist individuals with dementia, and family members have typically fulfilled that role. Personal strengths such as resilience, sense of coherence, and optimism have been shown to protect caregivers from some of the negative experiences of providing care, though the family-related variables associated with these personal strengths are largely unknown. Hierarchical multiple regressions investigated the extent to which family dynamics variables are associated with each of the caregiver personal strengths after controlling for demographic and caregiver characteristics. A sample of 105 caregivers from Argentina completed a set of questionnaires during a neurologist visit. Family dynamics explained 32% of the variance in resilience and 39% of the variance in sense of coherence. Greater family empathy and decreased family problems were uniquely associated with higher resilience. Greater communication and decreased family problems were uniquely associated with higher sense of coherence. Optimism was not found to be significantly associated with family dynamics. These results suggest that caregiver intervention research focused on the family may help improve caregiver personal strengths in Argentina and other Latin American countries