Treatment of Fatigue in Multiple Sclerosis Patients: A Neurocognitive Approach

The objective of the study was to treat fatigue in patients with multiple sclerosis (MS) by a neurocognitive rehabilitation program aimed at improving motor planning by using motor imagery (MI). Twenty patients with clinically definite MS complaining of fatigue were treated for five weeks with exercises of neurocognitive rehabilitation twice a week. Patients were evaluated by Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), MSQoL54, Expanded Disability Status Scale (EDSS), and MS Functional Composite (MSFC). After treatment, a decrease in fatigue was detected with both FSS (P = 0.0001) and MFIS (P = 0.0001). MSFC (P = 0.035) and MSQoL54 (P = 0.002) scores improved compared to baseline. At six-month followup, the improvement was confirmed for fatigue (FSS, P = 0.0001; MFIS P = 0.01) and for the physical subscale of MSQoL54 (P = 0.049). No differences in disability scales were found. These results show that neurocognitive rehabilitation, based on MI, could be a strategy to treat fatigue in MS patients

Effect of an early neurocognitive rehabilitation on autonomic nervous system in critically ill patients

Introduction Recent clinical and electrophysiological studies reveal a high incidence of autonomic nervous system (ANS) dys- function in patients treated in ICU [1]. ANS disturbances may produce diverse and unexpected consequences. For instance, critically ill patients are at risk of neurocognitive impairments that may persist after hospital discharge. Among various pathophysiological mechanisms proposed, ANS dysfunction leading cholinergic deficiency seems one of the most viable to explain the development of long-term sequelae. Heart rate variability (HRV) has been related to the activity of the prefrontal cortex [2] hence, prefrontal activation could help to strengthen the auto- nomic nervous system integrity. We are interested in assessing the improvement of the ANS dysfunction through neural circuits’ activation. Thus, we propose a novel therapy that could allow the reinforcing of ANS through an early neurocognitive intervention targeted to improve prefrontal activation. Objectives The aim of this study was to explore if the integrity of the ANS, via cardiac vagal tone, measured by the HRV can be modified after early neurocognitive rehabilitation in ICU patients. Methods A total of 17 critically ill patients received a 20-minute Early Neurocognitive Rehabilitation (ENR) session in their own bed in the ICU. HRV was derived from the recorded ECG signal during pre-session, session and post-session. Power in the specific frequency bands related to sympathetic and parasympathetic systems was computed (PLF and PHF for low and high frequency bands, respectively). PLF was computed within the clas- sic band, while PHF was computed within a band cen- tered at respiratory rate. Changes in the HRV parameters from pre-session to session, and from pre- session to post-session were studied using Wilcoxon signed-rank test. Results Clinical data of the sample are summarized in table 1. Comparing with baseline values, 9 patients (53%) showed a decreased PLF in post-session, while 8 patients (47%) presented a higher PLF (p = .759). In 12 patients (71%), PHF increased after the ENR session, suggesting an increase of parasympathetic activity (p = .836). Conclusions Diagnosis, severity of illness or medication could explain the differential effect in the evolution of the HRV para- meters among different patients. Despite differences, an early neurocognitive rehabilitation seems to increase parasympathetic activity after the session in the majority of the patients. Clinical characteristics of the critical ill patients should be further studied to determinate which patients could be the best candidates for early neurocog- nitive intervention

Neurorehabilitation for Multiple Sclerosis Patients with Emotional Dysfunctions

Depression frequently develops in multiple sclerosis (MS) patients, exacerbating the manifestations of the disease and making its management challenging. To date, no consensus has been reached regarding effective treatments for these sufferers due to limited understanding regarding the underlying mechanisms responsible for emotional disorders that are highly comorbid with this disease. There is an urgent need to rethink current treatment options for these patients. This article aims to optimize the treatment outcomes and improve the quality of life for MS patients. Based on an in-depth and critical review of the current literature, we provide a neurorehabilitative framework that explains possible regulatory mechanisms underlying the emotional symptoms highly developed in MS. This article offers practical knowledge and therapeutic strategies to optimize the treatment options in the current care system for MS, as well as for other disabling diseases. Approximately half of all patients with multiple sclerosis (MS) experience clinically significant depression at least once in their lifetimes and even more exhibit emotional symptoms. The depressive disorders observed in MS exacerbate the manifestations of the disease and make its management challenging (1). Yet, the majority of MS patients with depressive symptoms receive neither antidepressant medication nor psychotherapy. The side effect profile of conventional antidepressant treatments can complicate MS management, compromising treatment efficacy and compliance (2). No consensus to date has been reached regarding effective treatment options for these sufferers, due to limited understanding regarding the underlying mechanisms that may be responsible for the emotional disorders that are highly comorbid with MS. There is therefore an urgent need for clinicians and neuroscientists to rethink current treatment options for these patients and improve the quality of their care. Here, we provide a neurorehabilitative framework that explains possible regulatory mechanisms underlying the emotional symptoms frequently developed in MS and suggest practical strategies to optimize its treatment outcomes. Patients with MS, a heterogeneous central nervous system disease causing focal brain lesions and diffuse demyelination, suffer from pronounced physical and cognitive disabilities (3). Though retaining their intellectual abilities, MS patients exhibit various cognitive deficits involving both verbal and non-verbal memory, attention and speed of processing, as well as executive functioning. The progression of MS introduces a chronic stress in patients, associated with impaired neurocognitive functions and diminished brain resources (cognitive reserve), which involve pathology of not only the cortex but also deep brain structures, including the limbic system. In particular, impaired brain connectivity in MS patients has been observed between the prefrontal lobe and the amygdale (4) – brain circuits important for the regulation of emotions (Figures 1A,B) (5). Deficits in executive functions also contribute to problems of impulsivity and lack of emotional control. Abnormal emotional processing takes place in the dysregulated brain with limited neurocognitive resources, and the MS patients experience negative attentional bias and use maladaptive cognitive appraisal toward daily life events. These cognitive deficiencies create a susceptibility to the development of emotional symptoms and disorders such as depression (Figures 1B,C). Neuroimaging evidence suggests that the depressive symptoms in MS are related to the total extent of brain lesions and the degree of impaired cortical-subcortical connections.Canadian Institutes of Health ResearchAthinoula A. Martinos Center for Biomedical ImagingSt. Michael's Hospital. Department of the Neurosurgery-Neuroscience Research

La rehabilitación neurocognitiva en la esquizofrenia

Treball final de Grau en Psicologia. Codi: PS1048. Curs acadèmic 2014-2015La esquizofrenia es una enfermedad crónica que hace dependientes a muchas de las personas que la padecen. Los efectos cotidianos en los pacientes que conlleva la esquizofrenia son muchos y muy diversos. El desconocimiento de la enfermedad, así como los estereotipos y prejuicios que van unidos a ella, dificultan la integración de estas personas tanto en el mundo laboral como social. La rehabilitación neurocognitiva es un proceso terapéutico cuya finalidad es mejorar la capacidad para procesar y usar la información, así como también mejorar la calidad de vida diaria de los pacientes. En la actualidad el interés por este tema está en auge, y esto se puede observar en el aumento de publicaciones en los últimos años. Esta revisión bibliográfica pretende, mediante una búsqueda sistemática, realizar un recorrido de las dos últimas décadas utilizando tres bases de datos (PubMed, Scopus y PsycNet) para así abordar las publicaciones sobre la rehabilitación neurocognitiva en la esquizofrenia centrándose en los programas de tratamiento más utilizados (IPT, CET, CRT y NEAR). Pese a ser un tratamiento considerado como psicológico, sorprende que en las bases de datos consideradas como más psicológicas, el impacto de los tratamientos sea menor que en las otras. Cada uno de los tratamientos proporciona unas ventajas y unos inconvenientes que se espera que se mejoren en las futuras líneas de investigación. Hoy en día, tanto los estudios experimentales como las revisiones se están realizando con IPT y CRT, mientras que apenas existe investigación con los otros programasSchizophrenia is a chronic disease that makes them dependent on many of the people who have it. The effects daily in patients involved in schizophrenia are many and varied. The ignorance of the disease and the stereotypes and prejudices that are linked to it, hinder the integration of these people in both the workplace and socially. Neurocognitive rehabilitation is a therapeutic process that aims to improve the ability to process and use the information as well as improve the quality of daily life of patients. At present, the interest in this subject is booming, and this can be seen in the increase of publications in recent years. This literature review aims, through a systematic search, a tour of the past two decades using three databases (PubMed, Scopus and PsycNet) in order to address the publications on neurocognitive rehabilitation in schizophrenia by focusing on the most commonly used treatment programs (IPT, CET, CRT and NEAR). Although a psychological treatment considered surprising that in the databases considered more psychological impact of the treatments is lower than in the other. Each of the treatments provides advantages and disadvantages which are expected to improve in the future research. Today, both experimental studies and reviews are underway with IPT and CRT, whereas no research is done with the other programs

Dissociating Explicit and Implicit Timing in Parkinson\u2019s Disease Patients: Evidence from Bisection and Foreperiod Tasks

A consistent body of literature reported that Parkinson\u2019s disease (PD) is marked by severe deficits in temporal processing. However, the exact nature of timing problems in PD patients is still elusive. In particular, what remains unclear is whether the temporal dysfunction observed in PD patients regards explicit and/or implicit timing. Explicit timing tasks require participants to attend to the duration of the stimulus, whereas in implicit timing tasks no explicit instruction to process time is received but time still affects performance. In the present study, we investigated temporal ability in PD by comparing 20 PD participants and 20 control participants in both explicit and implicit timing tasks. Specifically, we used a time bisection task to investigate explicit timing and a foreperiod task for implicit timing. Moreover, this is the first study investigating sequential effects in PD participants. Results showed preserved temporal ability in PD participants in the implicit timing task only (i.e., normal foreperiod and sequential effects). By contrast, PD participants failed in the explicit timing task as they displayed shorter perceived durations and higher variability compared to controls. Overall, the dissociation reported here supports the idea that timing can be differentiated according to whether it is explicitly or implicitly processed, and that PD participants are selectively impaired in the explicit processing of time

Efficacy of ICT-based neurocognitive rehabilitation programs for acquired brain injury: a systematic review on Its assessment methods

This systematic review aims to analyze the methods used in the assessment of the efficacy of Neurocognitive Rehabilitation Programs (NRP) based on Information and Communication Technologies in patients with Acquired Brain Injury, namely platforms and online rehabilitation programs. Studies with the main purpose of evaluating the efficacy of those programs were retrieved from multiple literature databases, accordingly to inclusion and exclusion criteria. The inclusion and analysis of the studies followed preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) and Cochrane Collaboration Guidelines. Thirty-one studies were included in this review. Results showed that most studies used a pre-post methodological design, with few studies performing assessment moments during intervention or follow-up. Attention, memory, and executive functions were the cognitive variables considered by a larger number of studies at the assessment of NRP efficacy. Despite that, there is a growing evidence on the inclusion of variables related to everyday functioning in this process, increasing its ecological validity. Concerning the instruments used, the studies presented a large heterogeneity of the instruments and methods used, even for the same assessment purpose, highlighting a lack of consensus regarding assessment protocol. Psychophysiological and neuroimaging techniques are seldom used on this field. This review identifies the main characteristics of the methodology used at the assessment of NRP and potential limitations, providing useful information to guide the practice of the health care professionals in rehabilitation of Acquired Brain Injury. It also suggests new directions for future studies.info:eu-repo/semantics/acceptedVersio

EMERGENCY NURSING ANALYSIS PREVENTION AND TREATMENT OF COGNITIVE DYFUNCTION AFTER TRAUMATIC BRAIN INJURY: LITERATURE REVIEW

Introduction: Traumatic brain injury or traumatic brain injury according to the national consensus of treatment head trauma defines traumatic brain injury as mechanical trauma to the head either directly or indirectly that can cause disturbance neurological functions such as physical, cognitive and psychosocial disorders both temporarily nor permanent. This literature review aims to determine the prevention and treatment of cognitive dysfunction after traumatic brain injury. Literature search with using the ProQuest, PubMed, Garuda and Google Scholar databases with 2017-2022 publication range. Articles that meet the criteria are analyzed and rated quality according to inclusion and exclusion. Obtained ten articles discussing related to the prevention and treatment of cognitive dysfunction after traumatic brain injury, two articles using the literature review method. The results of the analysis of the 5 articles show below there are various alternatives can be used in the prevention and treatment of people with cognitive dysfunction or disorders positive after traumatic brain injury such as the use of trehalose drugs, computer-assisted cognitive stimulation or neurocognition, use of neurofeedback, prophylactic therapy, neuroradiographic imaging and basic and optional neurologic examinations use of anti-epileptic drugs (OATs). Until now there is no therapy that can be applied for primary brain injury, therapy for people with cognitive impairment focused on neurocognitive rehabilitation in cognitive impairment after traumatic brain injur