Cognitive rehabilitation following traumatic brain injury

Freire, Fabio Rios; Coelho, Fernanda; Lacerda, Juliana Rhein; Silva, Marcio Fernando da; Gonçalves, Vanessa Tome; Machado, Sergio; Velasques, Bruna; Ribeiro, Pedro; Basile, Luis Fernando Hindi; Oliveira, Arthur Maynart Pereira; Paiva, Wellingson Silva; Kanda, Paulo Afonso Medeiros; Anghinah, Renato

doi:10.1590/S1980-57642011DN05010004

Abstract

Annually, some 500,000 people are hospitalized with brain lesions acquired after traumatic brain injury (TBI) in Brazil. Between 75,000 and 100,000 individuals die within hours of the event and 70,000 to 90,000 evolve to irreversible loss of some neurological function. The principal causes of TBI include motor vehicle accidents (50%), falls (21%), assaults and robberies (12%) and accidents during leisure activities (10%). Within this context, cognitive rehabilitation, a clinical area encompassing interdisciplinary action aimed at recovery as well as compensation of cognitive functions altered as a result of cerebral injury, is extremely important for these individuals. Therefore, the aim of this study was to review the basic concepts related to TBI, including mechanisms of injury, severity levels of TBI, the most common findings in moderate and severe TBI survivors, and the most frequent cognitive impairments following TBI, and also to discuss the strategies used to handle patients post-TBI. The study results yielded relevant information on a structured cognitive rehabilitation service, representing an alternative for patients and families afflicted by TBI, enabling the generation of multiple research protocols.

Key words:
TBI; traumatic brain injury; cognitive rehabilitation

Resumo

Anualmente, 500 mil pessoas são hospitalizadas com lesão cerebral adquirida após traumatismo crânio-encefálico (TCE) no Brasil. Setenta e cinco a cem mil pessoas morrem poucas horas após o evento e 70 a 90 mil evoluem para perda irreversível de alguma função neurológica. Entre as principais causas de TCE estão os acidentes automobilísticos (50%), quedas (21%), assaltos e roubos (12%) e atividades de lazer (10%). Dentro deste contexto, a reabilitação cognitiva, uma área clínica de atuação interdisciplinar em busca de recuperação, tanto quanto a compensação de alterações das funções cognitivas resultantes de lesão cerebral, é extremamente importante para estes indivíduos. Portanto, neste estudo, foram revisados os conceitos básicos relacionados ao TCE, tais como os mecanismos de lesão, os níveis graves de TCE, os achados mais comuns em sobreviventes de TCE moderado e grave e as deficiências cognitivas mais comuns após TCE e discutidas as estratégias utilizadas para lidar com pacientes pós-TCE. Como resultado, nosso estudo irá fornecer informações relevantes relacionadas com um serviço de reabilitação cognitiva estruturada e, certamente, irá oferecer uma alternativa para pacientes e famílias vítimas de TCE e, portanto, gerar múltiplos protocolos de pesquisa.

Palavras-chave:
TCE; traumatismo crânio-encefálico; reabilitação cognitiva

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References

Jang SH. Review of motor recovery in patients with traumatic brain injury. NeuroRehabilitation 2009;24:349-53.
Cattelani R, Zettin M, Zoccolotti P. Rehabilitation treatments for adults with behavioral and psychosocial disorders following acquired brain injury: a systematic review. Neuropsychol Rev 2010;20:52-85.
Schewinsky SR. In Reabilitação neuropsicológica da memória no TCE. 1ª Ed., São Paulo, SP: Livraria Médica Paulista, 2008.
Harmon RL, Lawrence JH. Traumamatic brain injury. In: Bryan J, Mark A, Steven A (Editors). Phisical medicine and rehabilitation secrets, 2ª ed., Philadelphia: Mosby, 2001.a 2008: xvii.
Cappa SF, Benke T, Clarke S, Rossi B, Stemmer B, van Heugten CM. Task force on cognitive rehabilitation: European Federation of Neurological Societies. EFNS guidelines on cognitive rehabilitation: report of an EFNS task force. Eur J Neurol 2005;12:665-680.
Thornton KE, Carmody DP. Efficacy of traumatic brain injury rehabilitation: interventions of QEEG-guided biofeedback, computers, strategies, and medications. Appl Psychophysiol Biofeedback 2008;33:101-124.
Sohlberg MM, Mateer CA. Cognitive rehabilitation. London: The Guilford Press, 2001.
Jennett B, Snoak J, Bond M, Brooks N. Disability after severe head injury: observations on use of Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 1981;44:285-293.
Silva SCF, Sousa RMC. Galveston orientation and amnesia test: tradução e validação. Acta Paul Enferm 2007:24-29.
Mansur LL, Radanovic M, (Editores). Neurolinguistica: princípios para a prática clínica. São Paulo: Edições Inteligentes, 2004.
Braakman R, Jennett WB, Minderhoud JM. Prognosis of the posttraumatic vegetative state. Acta Neurochir 1988;95:49-52.
Hagen C. Language cognitive disorganization following closed head injury: a conceptualization. In: Trexler L (editor). Cognitive rehabilitation: conceptualization and intervention. New York: Plenum Press 1982:131-151.
Tuel SM, Presty SK, Meythaler JM, Heinemann AW, Katz RT. Functional improvement in severe head injury after readmission for rehabilitation. Brain Inj 1992 6:363-372.
Katz RT, DeLuca J. Sequelae of minor traumatic brain injury. Am Fam Physician 1992;46:1491-1498.
Zafonte RD, Hammond FM, Mann NR, Wood DL, Black KL, Millis SR. Relationship between Glasgow coma scale and functional outcome. Am J Phys Med Rehabil 1996;75:364-369.
Vallat-Azouvi C, Weber T, Legrand L, Azouvi P. Working memory after severe traumatic brain injury. J Int Neuropsychol Soc 2007;13:770-780.
Folstein MH, Folstein SM, McHugh PR. "Mini-Mental State": a practical method for grading the cognitive state of patients for clinicians. J Psychiat Res 1975;12:189-198.
Bertolucci PHF, Mathias SC, Brucki SMD, Carrilho PEM, Okamoto IH, Nitrini R. Proposta de padronização do Mini-Exame do Estado Mental (MEEM): estudo piloto cooperativo (FMUSP/EPM). Arq Neuropsiquiatr 1994;52:225.
Cunha JA. Manual da versão em português das escalas de BECK. São Paulo: Casa do Psicólogo, 2001.
Lipp MEN. Inventário de sintomas de stress para adultos de LIPP (ISSL). São Paulo: Casa do Psicólogo , 2000.
Yesavage JA. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982-83;17:37-49.
Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
Wisconsin Card Sorting Test. Psychological assessment resources, Inc- Odessa, 1993.
Sawchyn JM, Brulot MM, Strauss E. Note on the use of the Postconcussion Syndrome Checklist. Arch Clin Neuropsychol 2000;15:1-8.
Otfried Spreen, Esther Strauss. Compendium of neuropsychological tests: administration, norms, and commentary, 2ª Ed. New York: Oxford University Press, 1998.
Rey A. L'examen psychologique dans les cas d'encephalopathie traumatique. Arch Psychol 1941;28:286-340.
Wechsler D. Wechsler Adult Intelligence Scale. 3. New York: Psychological Corporation, 1997.
Trail Making Test. In: Spreen O, Strauss E, (Editors). A compendium of neuropsychological tests: administration, norms, and commentary, 2ª Ed. New York: Oxford University Press 1998:533-546.
Brucki SMD, Rocha MSG. Category fluency test: effects of age, gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res 2004;37:1771-1777.
Rey-Osterrieth complex figure test (SFT). In: Spreen O, Strauss E, (Editors). A compendium of neuropsychological tests: administration, norms, and commentary, 2ª Ed. New York: Oxford University Press 1998:341-363.
Bayles KA, Tomoeda CK. Arizona battery for communication disorders of dementia. Tucson: Canyonlands Publishing, 1994.
Erez ABH, Rothschild E, Katz N, Tuchner M, Hartman-Maeir A. Executive functioning, awareness, and participation in daily life after mild traumatic brain injury: a preliminary study. Am J Occup Ther 2009;63:634-640.
Powell JM, Temkin NR, Machamer JE, Dikmen SS. Gaining insight into patients' perspectives on participation in home management activities after traumatic brain injury. Am J Occup Ther 2007;61:269-279.
Hartman-Maeir A, Katz N, Baum CM. Cognitive functional evaluation (CFE) process for individuals with suspected cognitive disabilities. Occupational Therapy in Health Care 2009;23:1-23.
Katz N, Itzkovich M, Averbuch S, Elazar B. Loewenstein occupational. Therapy cognitive assessment (LOTCA) battery for brain-injured patients: reliability and validity. Am J Occup Ther . 1989 Mar;43(3):184-192.
Brayman SJ, Clark GF, DeLany JV, et al. Commission on practice: guidelines for supervision, roles, and responsibilities during the delivery of occupational therapy services. Am J Occup Ther 2009;63:797-803.
Skinner BF. The operant side of behavior therapy. J Behav Ther Exp Psychiatry 1988;19:171-179.
Lear Kathy. Help us Learn. In: A self-paced training program for ABA. Part I: training manual. 2ª Ed. Toronto, 2004.

Publication Dates

Publication in this collection
Jan-Mar 2011

History

Received
17 Dec 2010
Accepted
17 Feb 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Jang SH. Review of motor recovery in patients with traumatic brain injury. NeuroRehabilitation 2009;24:349-53.

[2] Cattelani R, Zettin M, Zoccolotti P. Rehabilitation treatments for adults with behavioral and psychosocial disorders following acquired brain injury: a systematic review. Neuropsychol Rev 2010;20:52-85.

[3] Schewinsky SR. In Reabilitação neuropsicológica da memória no TCE. 1ª Ed., São Paulo, SP: Livraria Médica Paulista, 2008.

[4] Harmon RL, Lawrence JH. Traumamatic brain injury. In: Bryan J, Mark A, Steven A (Editors). Phisical medicine and rehabilitation secrets, 2ª ed., Philadelphia: Mosby, 2001.a 2008: xvii.

[5] Cappa SF, Benke T, Clarke S, Rossi B, Stemmer B, van Heugten CM. Task force on cognitive rehabilitation: European Federation of Neurological Societies. EFNS guidelines on cognitive rehabilitation: report of an EFNS task force. Eur J Neurol 2005;12:665-680.

[6] Thornton KE, Carmody DP. Efficacy of traumatic brain injury rehabilitation: interventions of QEEG-guided biofeedback, computers, strategies, and medications. Appl Psychophysiol Biofeedback 2008;33:101-124.

[7] Sohlberg MM, Mateer CA. Cognitive rehabilitation. London: The Guilford Press, 2001.

[8] Jennett B, Snoak J, Bond M, Brooks N. Disability after severe head injury: observations on use of Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 1981;44:285-293.

[9] Silva SCF, Sousa RMC. Galveston orientation and amnesia test: tradução e validação. Acta Paul Enferm 2007:24-29.

[10] Mansur LL, Radanovic M, (Editores). Neurolinguistica: princípios para a prática clínica. São Paulo: Edições Inteligentes, 2004.

[11] Braakman R, Jennett WB, Minderhoud JM. Prognosis of the posttraumatic vegetative state. Acta Neurochir 1988;95:49-52.

[12] Hagen C. Language cognitive disorganization following closed head injury: a conceptualization. In: Trexler L (editor). Cognitive rehabilitation: conceptualization and intervention. New York: Plenum Press 1982:131-151.

[13] Tuel SM, Presty SK, Meythaler JM, Heinemann AW, Katz RT. Functional improvement in severe head injury after readmission for rehabilitation. Brain Inj 1992 6:363-372.

[14] Katz RT, DeLuca J. Sequelae of minor traumatic brain injury. Am Fam Physician 1992;46:1491-1498.

[15] Zafonte RD, Hammond FM, Mann NR, Wood DL, Black KL, Millis SR. Relationship between Glasgow coma scale and functional outcome. Am J Phys Med Rehabil 1996;75:364-369.

[16] Vallat-Azouvi C, Weber T, Legrand L, Azouvi P. Working memory after severe traumatic brain injury. J Int Neuropsychol Soc 2007;13:770-780.

[17] Folstein MH, Folstein SM, McHugh PR. "Mini-Mental State": a practical method for grading the cognitive state of patients for clinicians. J Psychiat Res 1975;12:189-198.

[18] Bertolucci PHF, Mathias SC, Brucki SMD, Carrilho PEM, Okamoto IH, Nitrini R. Proposta de padronização do Mini-Exame do Estado Mental (MEEM): estudo piloto cooperativo (FMUSP/EPM). Arq Neuropsiquiatr 1994;52:225.

[19] Cunha JA. Manual da versão em português das escalas de BECK. São Paulo: Casa do Psicólogo, 2001.

[20] Lipp MEN. Inventário de sintomas de stress para adultos de LIPP (ISSL). São Paulo: Casa do Psicólogo , 2000.

[21] Yesavage JA. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982-83;17:37-49.

[22] Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[23] Wisconsin Card Sorting Test. Psychological assessment resources, Inc- Odessa, 1993.

[24] Sawchyn JM, Brulot MM, Strauss E. Note on the use of the Postconcussion Syndrome Checklist. Arch Clin Neuropsychol 2000;15:1-8.

[25] Otfried Spreen, Esther Strauss. Compendium of neuropsychological tests: administration, norms, and commentary, 2ª Ed. New York: Oxford University Press, 1998.

[26] Rey A. L'examen psychologique dans les cas d'encephalopathie traumatique. Arch Psychol 1941;28:286-340.

[27] Wechsler D. Wechsler Adult Intelligence Scale. 3. New York: Psychological Corporation, 1997.

[28] Trail Making Test. In: Spreen O, Strauss E, (Editors). A compendium of neuropsychological tests: administration, norms, and commentary, 2ª Ed. New York: Oxford University Press 1998:533-546.

[29] Brucki SMD, Rocha MSG. Category fluency test: effects of age, gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res 2004;37:1771-1777.

[30] Rey-Osterrieth complex figure test (SFT). In: Spreen O, Strauss E, (Editors). A compendium of neuropsychological tests: administration, norms, and commentary, 2ª Ed. New York: Oxford University Press 1998:341-363.

[31] Bayles KA, Tomoeda CK. Arizona battery for communication disorders of dementia. Tucson: Canyonlands Publishing, 1994.

[32] Erez ABH, Rothschild E, Katz N, Tuchner M, Hartman-Maeir A. Executive functioning, awareness, and participation in daily life after mild traumatic brain injury: a preliminary study. Am J Occup Ther 2009;63:634-640.

[33] Powell JM, Temkin NR, Machamer JE, Dikmen SS. Gaining insight into patients' perspectives on participation in home management activities after traumatic brain injury. Am J Occup Ther 2007;61:269-279.

[34] Hartman-Maeir A, Katz N, Baum CM. Cognitive functional evaluation (CFE) process for individuals with suspected cognitive disabilities. Occupational Therapy in Health Care 2009;23:1-23.

[35] Katz N, Itzkovich M, Averbuch S, Elazar B. Loewenstein occupational. Therapy cognitive assessment (LOTCA) battery for brain-injured patients: reliability and validity. Am J Occup Ther . 1989 Mar;43(3):184-192.

[36] Brayman SJ, Clark GF, DeLany JV, et al. Commission on practice: guidelines for supervision, roles, and responsibilities during the delivery of occupational therapy services. Am J Occup Ther 2009;63:797-803.

[37] Skinner BF. The operant side of behavior therapy. J Behav Ther Exp Psychiatry 1988;19:171-179.

[38] Lear Kathy. Help us Learn. In: A self-paced training program for ABA. Part I: training manual. 2ª Ed. Toronto, 2004.

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