Rehabilitación cognitiva de pacientes con alteraciones perceptivas sobrevivientes a ictus isquémico

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Abstract

Se realizó una intervención terapéutica en 30 pacientes con déficit motor (hemiplejía/ hemiparesia), sobrevivientes a ictus isquémico, irrigado por la arteria cerebral media con alteraciones perceptivas (negligencia sensorial, atencional o anosognosia), atendidos en el Departamento de Rehabilitación del Hospital General Docente “Dr. Juan Bruno Zayas Alfonso”, de Santiago de Cuba, desde enero hasta noviembre del 2016, con vistas a evaluar la efectividad del tratamiento rehabilitador. La muestra fue dividida en 2 grupos de 15 integrantes cada uno: los del grupo control recibieron tratamiento convencional; los del grupo de estudio, tratamiento convencional y terapia ocupacional asociada a rehabilitación cognitiva. Se consideraron parámetros sociodemográficos, de valoración clínica y funcional, así como de recuperación funcional global. La heminegligencia resultó ser la alteración perceptiva más frecuente (63,4 %) y al finalizar el tratamiento el grupo de estudio mostró una mejor recuperación funcional (93,3 %), por lo cual quedó demostrada la eficacia de la rehabilitación convencional integrada a técnicas cognitivas y terapia ocupacional

Translated abstract

A therapeutic intervention in 30 patients with motor deficit (hemiplegia/hemiparesis), surviving to ischemic ictus, irrigated by the mean cerebral artery with perceptive disorders (sensorial or atentional negligence or anosognosia), assisted in the Rehabilitation Department of “Dr. Juan Bruno Zayas Alfonso” Teaching General Hospital, was carried out in Santiago de Cuba, from January to November, 2016, aimed at evaluating the effectiveness of the rehabilitative treatment. The sample was divided in 2 groups of 15 members each: those of the control group received conventional treatment; those of the study group, conventional treatment and occupational therapy associated with cognitive rehabilitation. They were considered sociodemographic parameters, of clinical and functional valuation, as well as of global functional recovery. Heminegligence was the most frequent perceptive disorder (63.4%) and the study group showed a better functional recovery (93.3%) when concluding the treatment, reason why the effectiveness of the conventional rehabilitation integrated to cognitive techniques and occupational therapy was demonstrated

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Most cited references 14

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Scot Olivier, Tamara Leclercq, P Bartolomeo … (2002)

The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke. Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations. The most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. About 85% of patients presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged. The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.

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Unawareness of disease following lesions of the right hemisphere: Anosognosia for hemiplegia and anosognosia for hemianopia

Anna Berti, Costanza Papagno, Daniela Perani … (1986)

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Rehabilitation of neglect: an update.

Georg Kerkhoff, Thomas Schenk (2012)

Spatial neglect is a characteristic sign of damage to the right hemisphere and is typically characterized by a failure to respond to stimuli on the left side. With about a third of stroke victims showing initial signs of neglect, it is a frequent but also one of the most disabling neurological syndromes. Despite partial recovery in the first months after stroke one third of these patients remain severely disabled in all daily activities, have a poor rehabilitation outcome and therefore require specific treatment. The last decades have seen an intensive search for novel, more effective treatments for this debilitating disorder. An impressive range of techniques to treat neglect has been developed in recent years. Here, we describe those techniques, review their efficacy and identify gaps in the current research on neglect therapy. Copyright © 2012 Elsevier Ltd. All rights reserved.