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Acquired brain injury (ABI): rehabilitation and cognitive stimulation

What is ABI?

Acquired brain injury (ABI) is the result of a sudden injury to the brain that produces various physical, psychological and sensory sequelae, causing abnormalities in sensory perception, cognitive alterations and emotional disturbances.

Most common causes of ABI

The most common causes of ABI are cerebrovascular accidents (CVA or stroke), traumatic brain injury (TBI), brain tumors, cerebral anoxias and brain infections.

CVA or stroke

A more or less sudden interruption of blood flow in a region of the brain. This results in ischemia and a loss of the function for which the affected area of the brain is responsible.

TBI

Sudden absorption of a large amount of kinetic energy. The most common injuries are contusions due to blow and kickback, contusions due to friction with the bony structures of the skull base and diffuse axonal injury. This type of injury is usually accompanied, in the initial stages, by the formation of cerebral edema and consequent loss of consciousness or “coma”. The depth of loss of consciousness and its duration are two of the main markers for establishing the severity of brain damage.

Brain tumor

A group of abnormal cells that grow and multiply in or around the brain. Tumors can destroy healthy brain cells or damage them indirectly by invading other parts of the brain and causing brain swelling and pressure inside the skull. They are classified according to where they are located or the types of cells they involve. They can be benign or malignant, depending on how fast they grow and whether they can be resected or cured by neurosurgical treatment (ASATE).

Problems resulting from ABI

Alertness level

The “Glasgow Coma Scale” measures activity, the ability to keep the eyes open spontaneously or in response to a stimulus, the ability to move a limb on command or stimulation, and the patient’s ability to respond verbally.

Some patients, the minority, do not “wake up” from coma, becoming permanent (vegetative state).

Cognition and communication

Some of these problems may be transient and reversible (post-traumatic amnesia). Others may condition the person’s autonomy permanently.

In other cases they can keep it intact, generating a false impression of health.

In communication, difficulties may arise in understanding verbal language (sensory predominance aphasia) or being unable to read (alexia) or having difficulties in emitting understandable language (motor predominance aphasia).

Other times the person is unable to name everyday objects (anomia). Language disorders are often accompanied by problems of comprehension and expression.

Speech articulation disorders are very common, the articulation points of phonemes are not found, so the intelligibility of his speech can be severely affected, dysarthria. Other times, it is the emission of the voice that generates problems (dysphonia) and the person only manages to produce a small whisper to communicate.

Motor control

We can find weakness in the part of the body opposite to that of the injured cerebral hemisphere: hemiplegias (paralysis of half of the body) hemiparesis (loss of strength and dexterity in half of the body).

Emotions and personality

There is usually an instability of emotions, depression or loss of control over the expression of crying or laughter. In cases of stroke, the appearance of a depressive syndrome is particularly frequent.

Within the personality disorders, the disinhibited (inability to restrain impulses) and apathetic (emotional indifference, lack of motivation and inactivity). Behavioral problems may appear, such as aggressiveness.

Basic activities of daily living

Difficulties may appear in common activities that we perform daily (toileting, dressing, sphincter control, moving around…). Instrumental activities have to do with how the person gets around in the environment (use of public transport, bank transactions, shopping, administrative procedures and work performance).

Receiving information

Visual capacity may be affected, with a visual field disorder (hemi or quadrantanopsia) or visual convergence disorder (diplopia).

The affected person loses the ability to perceive visual stimuli coming from the part of the space contralateral to the hemisphere where the lesion is located. They are called hemianopsias when half of the visual field is affected; when a quadrant is affected, they are called quadrantanopsias. In convergence problems the most common problem is double vision.

It is common in TBI patients with lesions located in the most ventral region of the frontal lobes to lose their sense of smell, which is called hyposmia or anosmia, depending on the degree of severity of the symptom. Frequently these people report that food lacks taste (ageusia) due to the close relationship between smell and taste.

Hearing is mainly affected in TBI patients with a fracture of the temporal bone scale (inner ear), which is responsible for the sense of hearing. The sense of balance may also be affected, as it is highly dependent on structures closely related to the inner ear.

Touch is affected because the lesions that affected persons suffer often result in sensory disturbances of the contralateral region of the body. Consequently, there are difficulties in identifying pain, heat-cold, receiving information about the shape of objects, their texture or consistency, and there may even be the possibility of not feeling certain parts of the body and their position in space.

Characteristics of people with ABI

In addition to what has already been mentioned, it is common for people with ABI to have a very reduced awareness of their sequelae and their implications, even assuring that they are in perfect condition. Consequently, tensions are generated in the family circle, which tries to protect the affected person from initiatives that may be irresponsible given the new situation. Situations such as wanting to go back to driving or to work are often the cause of these disagreements.

ADACEBUR Association

ADACEBUR is the Asociación de Daño Cerebral Adquirido de Burgos (Acquired Brain Injury Association of Burgos, Spain) . It was born in May 2006 with the intention of helping people with acquired brain injury and their relatives, who after the injury need information and orientation about their situation, their possibilities, the resources they can access, etc.

We are a non-profit organization, formed by people who have suffered an acquired brain injury (ABI), their families and collaborating partners who wish to help in the association. We are integrated in the Spanish Federation of Brain Damage (Federación Española de Daño Cerebral, FEDACE.)

Objectives

Programs

Information, guidance and counseling

Aimed at affected persons and their families. The aim of this service is to respond to the social needs of patients and their families by providing information and processing of existing social services and resources to facilitate the integration of this group into society.

Neuropsychological rehabilitation

Focused on recovering, as far as possible, the level of intellectual functioning through intervention techniques based on attention, memory or comprehension exercises, to cite the most significant examples. The neuropsychologist evaluates throughout the rehabilitation process the patient’s changes in the different areas involved in thinking.

Occupational therapy

Individual activities are carried out, with exercises to change dominance and training in the improvement of the patient’s body scheme, through coordination, skill and strength exercises.

Also group activities, cognitive stimulation and emotional and social management. Work is done by encouraging collaboration and interaction of the group members.

Group and individual activities of training in technical aids and the performance of ADLs, to promote the personal autonomy of those affected.

Speech therapy

The professional is in charge of exploring, evaluating and diagnosing communication and language disorders and establishing a prognosis of evolution. Language assessment is performed at the following levels: phonological, lexical, morphological, syntactic, semantic, pragmatic and comprehension. Swallowing is also examined, since this function is frequently altered in ABI.

Physiotherapy

Sessions at home or at the center. Functional rehabilitation develops a set of individualized physiotherapy techniques adapted to the characteristics and special circumstances of each person. It includes a whole range of therapeutic activities aimed at enhancing the functional autonomy of patients with ABI and improving their physical condition.

Community awareness

Awareness campaigns are carried out through Adacebur for the general population. ABI and road prevention. Informative talks are given in social and cultural centers, schools and universities.

Other events

Visits to exhibitions, participation in sports, leisure and free time activities, training days on ABI.

Methodology

Our association has been offering neuropsychology services since 2006 since many of those affected by acquired brain damage need to work on different cognitive areas.

Normally when a person arrives at the association a neuropsychological assessment is made to check the patient’s condition and degree of it (unless they already have it done because they come from some other center) from which a report is made for the patient with recommendations and work proposals, with all the multidisciplinary team, depending on their needs. The assessment can be done again in time, due to the need to provide it in any legal process or process of incapacity for work, it can also be done after at least six months to see if there is improvement or progress in cognitive functions that are working from the rehabilitation sessions.

Professionals

We have a multidisciplinary team of professionals to respond to the needs of each patient, since no two patients are alike.

We hold periodic meetings to coordinate the rehabilitation of each patient and check if there is progress or if it is necessary to modify any aspect or therapy in each specific case.

Our experience with NeuronUP in ABI cases

During the pandemic that we have lived through, we saw the need to offer neurocognitive rehabilitation opportunities at a distance to the patients of the association, since with this situation many of them have been affected in their rehabilitation process and therefore their progress and improvement. Many of the pateints had to stop all the therapies they had been doing previously, seeing certain abilities and skills that had already improved again diminish. For all these reasons, we considered the possibility of acquiring the NeuronUP platform and we did so through a grant that was awarded to us in March of this year. Since then we have been using NeuronUP with our patients.

What do we work with NeuronUP?

We routinely use the NeuronUP program for both individual cognitive rehabilitation sessions and group cognitive stimulation sessions, both face-to-face.

Recently we have started to use NeuronUP2GO sessions, with a specific patient, to work from home, reinforcing what we see in the rehabilitation session and promoting greater autonomy of the person.

Thanks to NeuronUP we can speed up in some way the preparation of some sessions for patients, but the idea of being able to have a record of the patients and the activities they have been doing deserves special importance, since you can select the area of work you want to treat.

On the other hand, with the NeuronUP2GO sessions we have the advantage of being able to see the information on the patient’s results in the digitally programmed activities at home.

In the group sessions, the screen is projected and each patient must perform the activity, sometimes individually, so that everyone can reach the solution, and other times it is done jointly.

Likewise, in any of the modalities with which we work in the association we use worksheets, generators and games from the NeuronUP platform.

Future work

Our wish for the near future is to be able to continue using the NeuronUP platform with our patients and to see results in the medium and long term. In addition, we would like to see more and more participants using NeuronUP2GO from their homes and see their efforts reinforced.

Another good experience could be to share with other associations their direct experience with the use of the platform.

Conclusion

Although our work with NeuronUP is very recent, we can appreciate the interest it arouses in many of our patients and the cognitive benefits it can offer to its users. In addition, we value the facilities it offers to professionals when planning work sessions.

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