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Background The rate of recovery from the vegetative state (VS) is low. Currently, little is known of the mechanisms and cerebral changes that accompany those relatively rare cases of good recovery. Here, we combined functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) to study the evolution of one VS patient at one month post-ictus and again twelve months later when he had recovered consciousness. Methods fMRI was used to investigate cortical responses to passive language stimulation as well as task-induced deactivations related to the default-mode network. DTI was used to assess the integrity of the global white matter and the arcuate fasciculus. We also performed a neuropsychological assessment at the time of the second MRI examination in order to characterize the profile of cognitive deficits. Results fMRI analysis revealed anatomically appropriate activation to speech in both the first and the second scans but a reduced pattern of task-induced deactivations in the first scan. In the second scan, following the recovery of consciousness, this pattern became more similar to that classically described for the default-mode network. DTI analysis revealed relative preservation of the arcuate fasciculus and of the global normal-appearing white matter at both time points. The neuropsychological assessment revealed recovery of receptive linguistic functioning by 12-months post-ictus. Conclusions These results suggest that the combination of different structural and functional imaging modalities may provide a powerful means for assessing the mechanisms involved in the recovery from the VS.

Diversos estudios plantean la importancia que tienen las funciones ejecutivas como la flexibilidad cognitiva, la inhibición y la memoria detrabajo en la toma de decisiones. En este estudio se pretende valorar si la memoria de trabajo y la flexibilidad cognitiva, procesos cognitivospresentes en la toma de decisiones, pueden explicar las alteraciones en el rendimiento de los pacientes con daño cerebral adquirido (DCA)en la Balloon Analogue Risk Task (BART). A 73 pacientes con DCA se les administró la BART, el Trail Making Test (TMTB) y el WisconsinCard Sorting Test (WCST), para valorar la flexibilidad cognitiva; y el subtest Letras y Números (LN) del WAIS-III para evaluar la memoria detrabajo. Los mismos test fueron administrados a un grupo control de 30 sujetos sin DCA. En el grupo clínico, las variables neuropsicológicasestudiadas incluidas para explicar la variación del BART$ fueron TMTB, p < .001, y WCST, p < .001. Observamos que únicamente laflexibilidad cognitiva valorada con WCST y TMTB pudo explicar las alteraciones en el rendimiento de los pacientes con DCA en la BART. Portanto, es lógico pensar que si el rendimiento de la BART depende de la flexibilidad cognitiva de estos pacientes, entonces es de esperar quedicha capacidad sea un buen factor predictivo en la toma de decisiones.

Introduction: Although impairment in decision-making is a frequent consequence of frontal lobe injury, few instruments evaluate decision-making in patients with acquired brain injury (ABI). Most are difficult to use and require a well-preserved ability of complex verbal comprehension and executive functions. We propose the Balloon Analogue Risk Task (BART) as an alternative instrument to evaluate decision-making in ABI. Material and Methods: Balloon Analogue Risk Task (BART) and Iowa Gambling Task (IGT) were administered to a clinical group of 30 patients with ABI and to a control group of 30 healthy participants; comparative study to assess possible differences in the results obtained; analysis to determine a possible correlation between the two tests between groups. Results: The results showed that BART is a sensitive instrument to detect differences in performance between a control group and a group of patients with ABI, p < .001, 95 % CI =537.21-1575.46,  but do not correlate with  IGT, p = .524, rab.c = ‒.134. Conclusions: Although IGT and BART were both designed to assess decision-making, the results obtained in our study show that the scores obtained by patients with ABI on both tests do not correlate. This clearly proves that IGT and BART measure different aspects of decision-making.

Visuo-spatial neglect predicts longer hospitalization, poorer recovery of motor skills and greater functional limitation. The aim of the present study was to analyze whether the combined administration of computerized cognitive rehabilitation with right hemifield eye-patching in patients with left spatial neglect following a right hemisphere stroke is more effective than computerized cognitive rehabilitation applied in isolation. Randomized clinical trial conducted in 28 patients. These were grouped into two experimental groups: single treatment group (ST) (n= 15) and combined treatment group (CT) (n= 13). All received an average of 15 one-hour sessions of computerized cognitive rehabilitation using the Guttmann, NeuroPersonalTrainer® telerehabilitation platform. Those patients in the TC group performed the sessions wearing a visual device with which the right hemifield of each eye was occluded. Following treatment, both the ST and the TC group showed improvements in neuropsychological examination protocol although there were no differences pre- and post-treatment on the functional scale in either group. Likewise, no statistically significant differences were observed in intergroup comparison. The results from this study indicate that combination treatment is not more effective than rehabilitation applied in isolation.

En este trabajo se evaluó la influencia de la variable cognitiva “búsqueda de sensaciones” en la toma de decisiones en 73 pacientes con daño cerebral adquirido (DCA) a través de un estudio no experimental, transversal y correlacional, mediante la utilización de la Balloon Analogue Risk Task (BART) y la sub escala de búsqueda de sensaciones de la UPPS-P. Como grupo control, se aplicaron las pruebas a 30 personas que cumplían con los criterios de inclusión y exclusión propuestos. Se utilizó la BART ya que permite una aplicación más rápida y ofrece una tarea de fácil ejecución y comprensión, que a diferencia de otros instrumentos no requiriere que la persona evaluada presente una capacidad de comprensión verbal compleja bien preservada. Además no existen estudios anteriores que correlacionen ambas pruebas. Como resultado se obtuvieron diferencias significativas entre el grupo clínico y el grupo control donde éste último mostró un nivel mayor de toma de riesgo en la BART y búsqueda de sensaciones en la sub escala UPPS-P. Tomando en cuenta la literatura revisada, los resultados obtenidos y la observación cualitativa del grupo clínico, podríamos sospechar que en la toma de decisionesse halla presente el componente de apatía, y motivación, pudiendo concluir que la búsqueda de sensaciones correlaciona positivamente con el desempeño y elaboración de la toma de decisiones.

The thalamus is known to play a key role in arousal regulation and support of human consciousness. Neuropathological studies have identified thalamic damage as one of the most common abnormalities present in the brains of patients who were in a vegetative state (VS) or a minimally-conscious state (MCS) state at the time of their deaths. Nonetheless, no in vivo studies of thalamic abnormalities in these patients have been conducted. Using high-resolution T1-weighted magnetic resonance images and a novel approach to shape analysis, we investigated thalamic global and regional changes in a sample of patients in a VS or an MCS. Group comparisons and correlations with clinical variables were performed for the total thalamic volume and for each surface vertex. Total thalamic volume was significantly lower in patients than in healthy volunteers. Shape analysis revealed significant bilateral regional atrophy in the dorso-medial body in patients compared to controls; this atrophy was more widespread in VS than in MCS patients. Lower thalamic volume was significantly correlated with worse Disability Rating Scale scores. Shape analysis suggested that the dorso-medial nucleus and the internal medullar lamina were the main regions responsible for this correlation. Our findings suggest that MCS and VS patients present different patterns of regional thalamic abnormalities, and that these differences partially explain their clinical profile.

Background This paper presents the design, development and first evaluation of an algorithm, named Intelligent Therapy Assistant (ITA), which automatically selects, configures and schedules rehabilitation tasks for patients with cognitive impairments after an episode of Acquired Brain Injury. The ITA is integrated in “Guttmann, Neuro Personal Trainer” (GNPT), a cognitive tele-rehabilitation platform that provides neuropsychological services. Methods The ITA selects those tasks that are more suitable for the specific needs of each patient, considering previous experiences, and improving the personalization of the treatment. The system applies data mining techniques to cluster the patients according their cognitive impairment profile. Then, the algorithm rates every rehabilitation task, based on its cognitive structure and the clinical impact of executions done by similar patients. Finally, it configures the most suitable degree of difficulty, depending on the impairment of the patient and his/her evolution during the treatment. Results The ITA has been evaluated during 18 months by 582 patients. In order to evaluate the effectiveness of the ITA, a comparison between the traditional manual planning procedure and the one presented in this paper has been done, taking into account: a) the selected tasks assigned to rehabilitation sessions; b) the difficulty level configured for the sessions; c) and the improvement of their cognitive capacities after completing treatment. Conclusions The obtained results reveal that the rehabilitation treatment proposed by the ITA is as effective as the one performed manually by therapists, arising as a new powerful support tool for therapists. The obtained results make us conclude that the proposal done by the ITA is very close to the one done by therapists, so it is suitable for real treatments.

Working memory is frequently impaired after traumatic brain injury (TBI). The present study aimed to investigate working memory deficits in patients with diffuse axonal injury and to determine the contribution of cerebral activation dysfunctions to them. Eighteen patients with severe TBI and 14 healthy controls matched for age and gender were included in the study. TBI patients were selected according to signs of diffuse axonal injury on computed tomography (CT) and without any evidence of focal lesions on MRI clinical examination. Functional magnetic resonance (fMRI) was used to assess brain activation during n-back tasks (0-, 2-, and 3-back). Compared to controls, the TBI group showed significant working memory impairment on the Digits Backwards (p = 0.022) and Letter-Number Sequencing subtests from the WAIS-III (p < 0.001) under the 2-back (p = 0.008) and 3-back (p = 0.017) conditions. Both groups engaged bilateral fronto-parietal regions known to be involved in working memory, although patients showed less cerebral activation than did controls. Decreased activation in TBI patients compared to controls was observed mainly in the right superior and middle frontal cortex. The correlation patterns differed between patients and controls: while the control group showed a negative correlation between performance and activation in prefrontal cortex (PFC), TBI patients presented a positive correlation in right parietal and left parahippocampus for the low and high working memory load, respectively. In conclusion, severe TBI patients with diffuse brain damage show a pattern of cerebral hypoactivation in the right middle and superior frontal regions during working memory tasks, and also present an impaired pattern of performance correlations.

Introduction: Although impairment in decision-making is a frequent consequence of frontal lobe injury, few instruments evaluate decision-making in patients with acquired brain injury (ABI). Most are difficult to use and require a well-preserved ability of complex verbal comprehension and executive functions. We propose the Balloon Analogue Risk Task (BART) as an alternative instrument to evaluate decision-making in ABI. Material and Methods: Balloon Analogue Risk Task (BART) and Iowa Gambling Task (IGT) were administered to a clinical group of 30 patients with ABI and to a control group of 30 healthy participants; comparative study to assess possible differences in the results obtained; analysis to determine a possible correlation between the two tests between groups. Results: The results showed that BART is a sensitive instrument to detect differences in performance between a control group and a group of patients with ABI, p < .001, 95 % CI =537.21-1575.46, but do not correlate with IGT, p = .524, rab.c = ‒.134. Conclusions: Although IGT and BART were both designed to assess decision-making, the results obtained in our study show that the scores obtained by patients with ABI on both tests do not correlate. This clearly proves that IGT and BART measure different aspects of decision-making.