Acquired Brain Damage Research Articles

Artificial intelligence and machine learning in disorders of consciousness.

As artificial intelligence and machine learning technologies continue to develop, they are being increasingly used to improve the scientific understanding and clinical care of patients with severe disorders of consciousness following acquired brain damage. We here review recent studies that utilized these techniques to reduce the diagnostic and prognostic uncertainty in disorders of consciousness, and to better characterize patients' response to novel therapeutic interventions. Most papers have focused on differentiating between unresponsive wakefulness syndrome and minimally conscious state, utilizing artificial intelligence to better analyze functional neuroimaging and electroencephalography data. They often proposed new features using conventional machine learning rather than deep learning algorithms. To better predict the outcome of patients with disorders of consciousness, recovery was most often based on the Glasgow Outcome Scale, and traditional machine learning techniques were used in most cases. Machine learning has also been employed to predict the effects of novel therapeutic interventions (e.g., zolpidem and transcranial direct current stimulation). Artificial intelligence and machine learning can assist in clinical decision-making, including the diagnosis, prognosis, and therapy for patients with disorders of consciousness. The performance of these models can be expected to be significantly improved by the use of deep learning techniques.

Intrathecal baclofen therapy as treatment for spasticity and dystonia: Review of cases in a pediatric palliative care unit

IntroductionPatients managed in the Pediatric Palliative Care Integral Unit (PPCIU) have serious neurological conditions that involve significant damage at central nervous system level. The movement disorder is a very common clinical problem and for the patients where an adequate control of muscle tone is not achieved with usual techniques or drugs, intrathecal baclofen therapy (IBT) should be considered. Materials and methodsDescriptive retrospective study based on the review of clinical records of patients who received IBT being followed by the PPCIU of Madrid Autonomous Region in the timeframe between September 2012 and February 2021. ResultsIBT was implanted in 8 patients affected by infantile cerebral palsy (ICP) with a Gross Motor Function Scale (GMFCS) IV–V, 3 patients was a Pantothenate kinase deficit-associated neurodegeneration (PKAN), 2 had Acquired Brain Damage, and the remaining 3 had, respectively, 2 glutaric aciduria type I (GA-1), and poly-malformative syndrome. In all patients we observed a period of clinical stability after IBT, we call this period “honeymoon”. Two patients died while in the honeymoon period, at 24.9 and 19.6 months from implantation of the pump; the median of duration of the honeymoon period in the remaining 14 was 14.4 months (IQ: 8.3–25.8). ConclusionsIBT was not only used in patients with non-progressive diseases, but also in the group of patients with neurodegenerative or progressive diseases. In all of them, after implantation of the device, we have objectified a period of clinical stability and a better control of muscle tone disorders.

Survival and predictive factors of clinical outcome in patients with severe acquired brain injury.

Despite the many tools available to modern medicine, predicting the neurological and functional status of patients after severe brain injury remains difficult. This analysis evaluates the outcomes of patients with the most severe degree of cerebral function impairment. Retrospective cohort study. Patients hospitalized in the long-term Intensive Care Unit (ICU) department in the Military University Hospital in Prague between 2015-2022. We analyzed patients with severe acquired brain damage from five distinct etiologies whose initial Glasgow Coma Scale (GCS) score was eight or less upon admission to ICU due to neurological damage. Several parameters reflecting the patients' clinical status were evaluated. Overall survival after discharge from the ICU was calculated according to the Kaplan-Meier model with comparison between traumatic (TR) and non-traumatic (non-TR) etiologies. The analyzed cohort of 221 patients consisted of 116 patients of TR and 105 of non-TR etiology. There was no significant difference in overall survival between TR and non-TR groups. The length of hospitalization in the ICU was similar in both groups with a median of 94 days. The majority of patients had an improvement of GCS during the hospitalization with a median improvement of five points. GCS improvement occurred in the vast majority of patients regardless of TR or non-TR etiology. We did not observe a statistically significant difference in mortality or log-term neurological status between patients with severe brain injury of traumatic or non-traumatic etiology for the duration of our follow-up. The majority of patients had improved GCS, were successfully decannulated, but remained disabled with severe limitations of functional independence. The return of the patient to normal life is a rehabilitation challenge, regardless of the etiology of brain injury, and is extremely influenced by the level of development of neurorehabilitation programs in individual institutions, the severity of brain injury, and the individual motivation of the patient.

Gait assessment by means of portable devices in patients with acquired brain damage

Gait assessment by means of portable devices in patients with acquired brain damage

Assessment of gait using portable devices in patients with acquired brain damage

Introducción. Los accidentes cerebrovasculares, también llamados ictus, son la segunda causa de muerte a nivel global y la primera de discapacidad adquirida. Dada la elevada incidencia de los ictus y la dependencia derivada de estos eventos, uno de los principales objetivos de su tratamiento es el reentrenamiento de la marcha, el cual busca recuperar la autonomía del paciente de cara a recobrar la funcionalidad en las actividades de la vida diaria y la inclusión social. Presentación del caso. Hombre de 46 años con diagnóstico de ictus hemorrágico hipertensivo en ganglios basales izquierdos con secuela motora de hemiparesia derecha. Se analizó la marcha de manera objetiva mediante dispositivos portátiles y se planteó el tratamiento rehabilitador específico oportuno en el paciente, quien había sufrido daño cerebral adquirido. Como sistemas de valoración se empleó la aplicación para teléfonos inteligentes Balanced Gait Test, y una electromiografía de superficie para registrar la actividad muscular durante la marcha. Al alta del tratamiento el paciente presentó un importante incremento de su capacidad funcional de la marcha, sin requerir productos de apoyo y con una velocidad que le permitía el desplazamiento en la comunidad sin limitaciones. Conclusiones. La incorporación de nuevas tecnologías al estudio de la marcha mediante dispositivos portátiles fáciles de aplicar en la práctica clínica permite hacer una evaluación precisa y objetiva de los resultados del tratamiento rehabilitador en pacientes con daño cerebral adquirido tras un accidente cerebrovascular.

Determination of probabilistic intersections related to acquired brain damage from the determination of a priori and a posteriori probabilities

Determination of probabilistic intersections related to acquired brain damage from the determination of a priori and a posteriori probabilities

Propuesta de adaptación del reglamento de balonmano para personas con parálisis cerebral o daño cerebral adquirido

At present, handball is a discipline that is not adapted to people with Cerebral Palsy or Acquired Brain Injury. The aim of this study is to develop a proposal for adapting the handball regulations for this group, taking as a reference the regulations and functional classification of football 7-a-side, adapted to these players. The basis of the adaptation process has been the regulations of the International Handball Federation and the functional classification of another sport adapted to people with cerebral palsy and acquired brain damage, Soccer 7. It is necessary to make an adaptation of the material, technical and tactical aspects, as well as sports facilities depending on the motor skills of the participants. The practice of physical-sports activity has multiple benefits at a social, emotional, physical, and psychological level, so including one more collective sport, the only one that already exists for this population, which is football 7-a-side, expanding their participation options sporty.

Functional brain networks in Developmental Topographical Disorientation.

Despite a decade-long study on Developmental Topographical Disorientation, the underlying mechanism behind this neurological condition remains unknown. This lifelong selective inability in orientation, which causes these individuals to get lost even in familiar surroundings, is present in the absence of any other neurological disorder or acquired brain damage. Herein, we report an analysis of the functional brain network of individuals with Developmental Topographical Disorientation ($n = 19$) compared against that of healthy controls ($n = 21$), all of whom underwent resting-state functional magnetic resonance imaging, to identify if and how their underlying functional brain network is altered. While the established resting-state networks (RSNs) are confirmed in both groups, there is, on average, a greater connectivity and connectivity strength, in addition to increased global and local efficiency in the overall functional network of the Developmental Topographical Disorientation group. In particular, there is an enhanced connectivity between some RSNs facilitated through indirect functional paths. We identify a handful of nodes that encode part of these differences. Overall, our findings provide strong evidence that the brain networks of individuals suffering from Developmental Topographical Disorientation are modified by compensatory mechanisms, which might open the door for new diagnostic tools.

Neuropsychological Profile of a Patient with Acquired Brain Damage Following Vascular Lesion of the Left Anterior Cingulate Cortex

Neuropsychological Profile of a Patient with Acquired Brain Damage Following Vascular Lesion of the Left Anterior Cingulate Cortex

Clinical Theragnostic Signature of Extracellular Vesicles in Traumatic Brain Injury (TBI).

Traumatic brain injury (TBI) is a common cause of disability and fatality worldwide. Depending on the clinical presentation, it is a type of acquired brain damage that can be mild, moderate, or severe. The degree of patient's discomfort, prognosis, therapeutic approach, survival rates, and recurrence can all be strongly impacted by an accurate diagnosis made early on. The Glasgow Coma Scale (GCS), along with neuroimaging (MRI (Magnetic Resonance Imaging) and CT scan), is a neurological assessment tools used to evaluate and categorize the severity of TBI based on the patient's level of consciousness, eye opening, and motor response. Extracellular vesicles (EVs) are a growing domain, explaining neurological complications in a more detailed manner. EVs, in general, play a role in cellular communication. Its molecular signature such as DNA, RNA, protein, etc. contributes to the status (health or pathological stage) of the parental cell. Brain-derived EVs support more specific screening (diagnostic and prognostic) in TBI research. Therapeutic impact of EVs are more promising for aiding in TBI healing. It is nontoxic, biocompatible, and capable of crossing the blood-brain barrier (BBB) to transport therapeutic molecules. This review has highlighted the relationships between EVs and TBI theranostics, EVs and TBI-related clinical trials, and related research domain-associated challenges and solutions. This review motivates further exploration of associations between EVs and TBI and develops a better approach to TBI management.

Determinación de intersecciones probabilísticas relacionadas con daño cerebral adquirido a partir de la determinación de probabilidades a priori y a posteriori.

The acquired brain damage is a common neurological disorder. Determine the probabilistic intersections of variables related to acquired brain damage from the determination of a priori and a posteriori probabilities. Analytical retrospective study. A descriptive analysis was carried out, confidence intervals were calculated to obtain the mean and the proportion with α = 0.05 considering the age of the patient and the diagnosis. An analysis of probabilistic intersection, a priori and a posteriori probability was performed considering diagnosis, sex and age decade; finally, chi squared was calculated. 736 patients were analyzed. The most frequent diagnosis was language disorder. The patients diagnosed with memory disorder were the youngest and those diagnosed with degenerative cognitive disorder the oldest. The probability that a patient with sequelae due to acquired brain damage arrives at the hospital, at the language pathology service, to be diagnosed with a language disorder and that this patient is also a man is 29.06%. The high prevalence of short and long-term disability generated by acquired brain damage highlights the importance of an early and timely detection and diagnosis so that it favors prompt and efficient specialized care.

The cognitive characteristics of music-evoked autobiographical memories: Evidence from a systematic review of clinical investigations.

In healthy adults, autobiographical memories (AMs) evoked by music appear to have unique cognitive characteristics that set them apart from AMs evoked by other cues. If this is the case, we might expect music cues to alleviate AM deficits in clinical disorders. This systematic review examines music-evoked autobiographical memories (MEAMs) in clinical populations, focusing on cognitive characteristics, and whether MEAMs differ from AMs evoked by other stimuli. We identified 15 studies featuring participants with Alzheimer's disease (AD), behavioral variant - Frontotemporal dementia (bv-FTD), acquired brain damage, and depression. We found that music evokes AMs in these disorders, and that familiar music was more likely to evoke AMs. Compared with healthy controls, AD participants had a relative advantage for MEAMs over picture-evoked AMs. People with damage to the medial prefrontal cortex showed preserved access to MEAMs in terms of frequency, but a relative disadvantage regarding the episodic richness for MEAMs, but not for memories cued by pictures, compared to controls. Participants with bv-FTD had fewer AMs evoked after both music and pictures than healthy controls. Across conditions, MEAMs were generally specific and retrieved fast, suggesting little retrieval effort. MEAMs were also positive, except in depression, where as many negative as positive AMs were produced. These findings suggest several underlying cognitive and affective mechanisms of MEAMs, including anxiety reduction, increased fluency, music-evoked emotions, reminiscence, and involuntary retrieval, and that these might be moderated by musical abilities and memory for music. In conclusion, MEAMs appear to be relatively well preserved, especially in AD. This article is categorized under: Psychology > Memory.

Computer-assisted training of executive functions in adult patients with non-progressive acquired brain damage – a pilot study on efficacy of a new therapeutic application

Executive dysfunction is most often caused by post-traumatic or post-stroke damage to the prefrontal regions of the brain. The aim of this study was to compare the efficacy of two computer-assisted therapy programs for executive dysfunctions in patients with acquired brain injury. Patients were trained using either a newly developed application ExeSystem (designed to help improve the ability to manage and control one’s own behavior by performing tasks imitating natural, everyday situations) or a combination of two commercial applications RehaCom and CogniPlus. Data collected after a three-week period of therapy conducted in two 15-person groups of participants indicated comparable efficacy of both therapy programs in improving quality of daily functioning, executive attention, as well as planning and problem-solving but not memory. The improvement in social competence (p = .028) was the only advantage of therapy with the ExeSystem. Therapeutic interactions using computer programs were shown to be positively evaluated by patients (p < .01). This study confirmed at least equal efficacy of computer-based executive function therapy using ExeSystem compared to RehaCom and CogniPlus. However, despite the implementation of a more ecological and comprehensive approach to the content of a new application, the benefits of this approach were limited.

Impact of Genetic Testing on Therapeutic Decision-Making in Childhood-Onset Epilepsies-a Study in a Tertiary Epilepsy Center.

We assessed the frequency of pediatric monogenic epilepsies and precision therapies at a tertiary epilepsy center. We analyzed medical records of children, born in 2006-2011 and followed at the Danish Epilepsy Center from January to December 2015; 357 patients were identified, of whom 27 without epilepsy and 35 with acquired brain damage were excluded. Of the remaining 295 children, 188 were consented for study inclusion and genetic testing. At inclusion, 86/188 had a preexisting genetic diagnosis and did not undergo further genetic testing. The 102 genetically unsolved patients underwent WES, which identified a (likely) pathogenic variant in eight patients and a highly relevant variant of unknown significance (VUS) in seven additional patients. Single nucleotide polymorphism array was performed in the remaining 87 patients and revealed no (likely) pathogenic copy number variants (CNVs). Patients with a genetic diagnosis had a significantly lower median age at seizure onset and more often had febrile seizures, status epilepticus, or neurodevelopmental impairment compared to those who remained genetically unsolved. Most common epilepsies were focal or multifocal epilepsies and developmental and epileptic encephalopathies (DDEs). Fifty-three patients, with a putative genetic diagnosis, were potentially eligible for precision therapy approaches. Indeed, genetic diagnosis enabled treatment adjustment in 32/53 (60%); 30/32 (93%) patients experienced at least a 50% reduction in seizure burden while only 4/32 (12.5%) became seizure-free. In summary, a genetic diagnosis was achieved in approximately 50% of patients with non-acquired epilepsy enabling precision therapy approaches in half of the patients, a strategy that results in > 50% reduction in seizure burden, in the majority of the treated patients.

Intrathecal baclofen therapy as treatment for spasticity and dystonia: Review of cases in a pediatric palliative care unit

IntroductionPatients managed in the Pediatric Palliative Care Integral Unit (PPCIU) have serious neurological conditions that involve significant damage at central nervous system level. The movement disorder is a very common clinical problem and for the patients where an adequate control of muscle tone is not achieved with usual techniques or drugs, intrathecal baclofen therapy (IBT) should be considered. Materials and methodsDescriptive retrospective study based on the review of clinical records of patients who received IBT being followed by the PPCIU of Madrid Autonomous Region in the timeframe between September 2012 and February 2021. ResultsIBT was implanted in 8 patients affected by infantile cerebral palsy (ICP) with a Gross Motor Function Scale (GMFCS) IV–V, 3 patients was a Pantothenate kinase deficit-associated neurodegeneration (PKAN), 2 had Acquired Brain Damage, and the remaining 3 had, respectively, 2 glutaric aciduria type I (GA-1), and poly-malformative syndrome. In all patients we observed a period of clinical stability after IBT, we call this period “honeymoon”. Two patients died while in the honeymoon period, at 24.9 and 19.6 months from implantation of the pump; the median of duration of the honeymoon period in the remaining 14 was 14.4 months (IQ: 8.3–25.8). ConclusionsIBT was not only used in patients with non-progressive diseases, but also in the group of patients with neurodegenerative or progressive diseases. In all of them, after implantation of the device, we have objectified a period of clinical stability and a better control of muscle tone disorders.

Arithmetic (Re-)Learning in Neurological Patients

Abstract. Background: Numbers are an integral part of our life. Being competent with numbers is crucial for coping with the challenging demands of our modern times. Anyone who lacks basic numerical and calculation skills due to, for example, lower education, developmental disorders or acquired brain damage is socially disadvantaged and destined to remain marginalized. Improvement of basic numerical and calculation skills must therefore be an important goal of cognitive rehabilitation and intervention. Methods: We summarize the most recent studies regarding the rehabilitation of simple calculation deficits in adult neurological patients. Results: Over the last decades, several studies have reported acquired selective deficits in number processing and calculation skills in adult brain-damaged patients. It has also been shown in single case-studies that targeted rehabilitation based on theoretical neuropsychological models may lead to significant improvements of acquired deficits. Discussion: Systematic interventions may be successful in the case of acquired calculation deficits. Improvement of numerical competence in adult patients are possible even in very unfavorable circumstances (e.g., chronic stage, older age, severe deficits). This finding is of high relevance as numbers are essential in our daily life, and deficits in number processing may have a strong impact on a person's every-day autonomy.

Advances and challenges in neurorehabilitation for acquired brain damage (Avances y desafíos en neurorrehabilitación del daño cerebral adquirido)

ABSTRACT This special issue, Research into Neurorehabilitation, presents systematic and empirical reviews of studies on therapies for patients with acquired brain damage and includes an interview with one of the leading figures in the field of neuropsychological rehabilitation, Prof. Barbara A. Wilson. Throughout the interview, Barbara A. Wilson explains why she decided to dedicate herself to this area of psychology and the challenges that this speciality will have to address in the future. The review and empirical studies in this special edition deal with the most pertinent and innovative treatment techniques in neurocognitive disorders, robotic systems applied to rehabilitation and other methodologies, and explore the latest advances in rehabilitation and brain function recovery and plasticity processes.

Management of Spasticity Caused by Thrombotic Brain Injury with Incobotulinumtoxina in a Young Patient: A New Paradigm

Case: Acquired brain damage is one of the most complex pathologies that affect the central nervous system, there is great variability in its pathophysiology, from traumatic focal injuries to diffuse axonal injuries, including spasticity. It supposes a great comorbidity and functional repercussion in patients, hindering their subsequent recovery. We report a case of a young patient with a history of quadriplegia due to acquired brain damage secondary to thrombosis of the dural sinus. The patient presented sensorimotor deficit, restricted function, and a great situation of dependency. He required three cycles of high doses of incobotulinumtoxinA (IncoBoNT) according to his specific need, the first infiltration was 800 U, the second 800 U, and the last 500 U over a period of 14 weeks. Thanks to the previous objectives agreement with the patient the results were satisfactory and relevant for him, presenting a great functional improvement of spasticity and associated pain, as assessed by the visual analog scale score.Conclusion: IncoBoNT at high doses and short intervals has been shown to be an effective and valuable tool for personalized treatment adapted to the needs of severely affected neurological patients.

Validation of the EDMUR scale, a tool to quantify the evolution of neurogenic dysphagia

Introduction: dysphagia is a frequent and serious symptom in people with brain damage and a tool is needed to quantify and objectify its evolution. Objective: to develop and validate an instrument to measure the evolution of dysphagia in a patient with acquired brain damage in order to facilitate decision-making during multidisciplinary treatment. Methods: a longitudinal, retrospective cross-sectional study that consists of two phases with the aim of developing a new tool. In the first phase the instrument is developed and in the second psychometric properties, after application to 83 patients, is analyzed together with content validity, convergent validity, validity of known groups, reliability, and sensitivity to change. Results: an instrument, the EDMUR scale, composed of 5 domains and 46 items was obtained. After expert judgment, all the items proposed in the scale design phase reached the minimum values of Aiken's V and CRV'. Cronbach's alpha (α) showed a good internal consistency. The correlation between the FOIS scale and the EDMUR obtained through Spearman's coefficient (rho) was direct and significant. The Kruskal-Wallis H-test revealed statistically significant differences between all the groups established according to the levels of the FOIS. For internal sensitivity, the Wilcoxon signed rank sum test was used, obtaining a significant difference between the two assessments. The external sensitivity of the scale obtained a direct and significant correlation. Conclusions: the EDMUR scale is a reliable, valid, and sensitive instrument for quantifying the evolution of dysphagia, thus improving the quality of treatments.

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Background:Victoria hospital a specialized COVID center in Bangalore saw more than 10,000 patients with COVID-19 infection who have been admitted. Most of them were moderate to severely or critically ill patients who are at risk of developing acute brain dysfunction (delirium). Neurotropism of SARS-CoV-2 and its neurological manifestations have now been confirmed. Hence to find the prevalence, risk factors for developing delirium in patients admitted with COVID-19 infection, was the objective of this research work.Methodology:The study includes 10,200 covid infected patient who were admitted to Victoria hospital, from June 2020 to June 2021. Among them 550 cases were found to have neuropsychiatric symptoms. Patients who were on life support, prisoners, patients were with pre-existing Psychiatric illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug dependence (Except ADS and NDS), suicide attempt were excluded. Patients who were blind or deaf were also excluded. Patient demographics, delirium assessments, and management strategies were noted and entered in Microsoft Excel sheets. The outcome was to determine the prevalence of delirium and to find any associated risk factors for delirium the next day.Results:Delirium was diagnosed in 106 patients.The mean age of patients was 60 years.68 % were males & 32 % were females. 80 % of them had medical history, 10 % had past history of Alcohol dependence. 40 % of cases were treated in ICU& 32 % of them were treated on Invasive mechanical ventilation (Ventilators). On investigations, inflammatory markers raised in almost all (C- reactive protein 100 %, D-dimmer 64% and Serum ferritin 69 %). Treatment given was Steroids (Dexamethasone IV) in 100%, Remdesivir in 85 %, Iv antibiotics (Cephalosporin) in 100 %. For Symptomatic delirium treatment Injection Haloperidol IV 1.5 mg to 5mg thrice per day to once daily in 98% cases, some received Quetiapine 12.5 mg to 100mg /day in 5% or Tab Olanzapine 2.5 mg to 10 mg per day in 9% cases. Delirium Mortality rate was 45 % and recovery rate was 55 %.Conclusions:Severe SARS-CoV2 infection may be associated with COVID-19 delirium. High mortality, (more than 50 %) is found in covid delirium patients. Hypoxia could be the main reason for delirium in Covid 19. Elevated inflammatory markers is associated with Delirium in covid 19 patients.