EVALUATION OF THE EFFECTIVENESS OF A COMPREHENSIVE PROGRAM OF REHABILITATION OFFERED ACCORDING TO DIFFERENT THERAPEUTIC PROTOCOLS IN REDUCING CHRONIC FRONTAL SYNDROME IN PATIENTS 10-YEARS FOLLOWING NEUROSURGERY FOR POST-TRAUMATIC INTRACEREBRAL HEMATOMA

Abstract

The aim of the study was to evaluate the effectiveness of a Comprehensive Program of Rehabilitation (CPReh) offered according to different therapeutic protocols in reducing chronic frontal syndrome in patients 10 years following neurosurgery for post-traumatic intracerebral hematoma.Out of 568 adult car accident patients who underwent neurosurgery for post-traumatic intracerebral hematoma between 2004 and 2010 at the Department of Neurosurgery and Neurotraumatology of the Jagiellonian University's Collegium Medicum in Krakow, 90 patients with OFC injury and Chronic Frontal Syndrome were selected for the study. Patients were divided into three groups A, B and C of 30 each, matched for age, gender and injury severity. The Comprehensive Rehabilitation Program (CPReh) (cf. Pąchalska 2008) was applied in all groups ten years after hospitalization and surgery for intracerebral hematoma and was conducted according to three therapeutic Protocols:- Protocol 1 administered in group A, combained cognitive training (CT) and the "Life Academy" program administered twice a week. The activities were continued as long as the patient was able and willing to continue (average 24 months 1.18).- Protocol 2 administered in group B, included CT and the "Academy of Life" program also administered twice a week but lasting for the standard period of about a year (average 12 months 1.03).- Protocol 3 administered in group C, included CT and the "Community Base Treatment" program similarly administered twice a week and also lasting about a year as standard (average 12 months 1.27).Evaluation of the effects of rehabilitation using the Frontal Behavioral Inventory (FBInv) was conducted 2 times: Study I (baseline, 10 years follow up after operation)-before the start of rehabilitation, Study II (follow up) after the end of rehabilitation according to all protocols.all or most of the positive or negative symptoms tested by FBInv, including neurological, cognitive, emotional and behavioral ones. A modified CPReh program administered with Protocol 1. in which combined cognitive training (CT) and the "Academy of Life" program is provided twice a week, but which continues as long as the patient was able and willing to continue, is more effective in reducing these symptoms, like the standard CPReh program administered with Protocol 2 or 3 administered only up to a year as a standard. It was also found that the "Academy of Life " program has also been shown to be a more effective component of CPReh than the Community Base Treatment.The improvement achieved by group A, in which a modified CPReh administered with Protocol 1. that provided the patient the opportunity to continue rehabilitation as long as the patient was able and willing to continue was more effective in the reduction of Chronic Frontal Syndrome than the standard CPReh administered with Protocols 2. and 3. for the patients in groups B and C.