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Background: 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., Method: 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., Results: 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., Conclusions: The results from this study indicate that combination treatment is not more effective than rehabilitation applied in isolation.

Introduction: Tham and Tegner proposed the Baking Tray Task (BTT) as a fast simple assessment test for detecting spatial negligence. However, very few studies have examined its validity as a diagnostic test., Aim: To analyse the diagnostic validity of the BTT by measuring its specificity and sensitivity in a sample of subjects with right hemisphere strokes., Subjects and Methods: Forty-eight patients with right hemisphere vascular lesions were distributed in two groups (negligence group, n = 35; non-negligence group, n = 13) according to the scores obtained in a battery of visuospatial examination tests. The participants' performance on the BTT was compared with that of a healthy control group (n = 12)., Results: The results showed a high level of sensitivity of the BTT, but low specificity. The performance on the BTT of eight of the 13 members of the non-negligence group was suggestive of negligence., Conclusions: The BTT has proved to be a sensitive test for the detection of spatial negligence. Yet, based on its low specificity, its use alone as a single diagnostic test is not recommended.

Introduction: Cerebral palsy is defined as a group of developmental disorders of movement and posture that causes social and cognitive deficits, emotional, and behavior disturbances., Aim: To study the relationship between executive functioning and behavior in children with cerebral palsy from the answers given by parents and teachers on the Behavior Rating Inventory of Executive Function (BRIEF) and on the System Assessment Adaptive Behavior (ABAS-II)., Patients and Methods: The sample consisted on 46 children with CP with a mean age of 10.26 ± 2.95 years. Forty-four of the 46 children were distributed in Gross Motor Function Classification System (GMFCS) into level I (n = 16), level II (n = 3), level III (n = 11), level IV (n = 10) and level V (n = 4)., Results: The results showed a relationship between BRIEF and ABAS-II. Furthermore, discrepancies between the responses from parents and teachers, both in the ABAS-II and in the BRIEF, were obtained., Conclusions: We found a significant relationship between executive functioning in children with cerebral palsy and adaptive behavior. We found discrepancies in the answers given by parents and teachers. Finally, the data showed that the higher motor impairment increases difficulties at home.

Introduction: Alternating hemiplegic of childhood is a predominantly sporadic neurodevelopmental syndrome of uncertain etiology, characterized by alternating transient attacks of hemiplegia. Additional features include tonic fits, dystonic posturing, ocular motor abnormalities and deficits in cognitive functioning., Case Report: A girl of 7 years-old with alternating hemiplegic of childhood. The first symptoms debut at 17 months of age in the form of lower limb weakness, migraine, nystagmus and hemiplegic crisis alternating both hemibodies. We administrate the Wechsler Intelligence Scale for Children IV (WISC-IV), the Conners Continuous Performance Test II (CPT-II), the Conners scales for parents (CPRS-48) and teachers (CTRS-28) and the Behavior Rating Inventory Executive Function (BRIEF)., Conclusions: In our study we found deficits in sustained attention, reduced speed of information processing, and difficulties in understanding, speaking and working memory. In addition, parents and teachers reported behavioral disturbances, difficulties inhibition capability, in self-control and in regulating emotions.

Objective: To assess whether, following a right-hemisphere stroke, the combined administration of computer-based cognitive rehabilitation and right hemifield eye-patching in patients with visuo-spatial neglect is more effective than computer-based cognitive rehabilitation alone., Methods: Twelve patients were randomized into two treatment groups: a single treatment group (n = 7) and a combination treatment group (n = 5). In both cases, the treatment consisted of a mean number of 15 sessions, each lasting 1 hour. Visuo-spatial neglect was assessed using a specific exploration protocol (Bell Cancellation Test, Figure Copying of Odgen, Line Bisection, Baking Tray Task and Reading Task). The functional effects of the treatment were assessed using the Catherine Bergego Scale., Results: Significant between-group differences were observed when comparing the pre- and post-treatment scores for the Reading Task. No differences were observed in either group in the Catherine Bergego Scale administered at baseline and at the final intervention., Conclusion: The results obtained do not allow one to conclude that the combination treatment with cognitive rehabilitation and right hemifield eye-patching is more effective than cognitive rehabilitation alone. Although partial improvement in the performance of neuropsychological tests was observed, this improvement is not present at functional level.

Introduction: Cerebral palsy is often accompanied by cognitive impairment affecting attention, visuoperception, executive functions and working memory. AIMS. To analyse the effect of cognitive stimulation treatment on the cognitive capabilities in children with cerebral palsy., Patients and Methods: Our sample consisted of 15 children with cerebral palsy, with a mean age of 8.80 ± 2.51 years, who were classified with the aid of the Gross Motor Function Classification System (GMFCS) on level I (n = 6), level II (n = 4), level III (n = 2) and level V (n = 3). Cognitive impairment was evaluated by means of the Wechsler Intelligence Scale for Children (WISC-IV) and the Continuous Performance Test (CPT-II). Both the questionnaires for parents and teachers from the Behavior Rating Inventory of Executive Function (BRIEF) and the Conners rating scales (CPRS-48 and CTRS-28) were administered. A cognitive stimulation programme was carried out at a rate of two hours a week for a total of eight weeks., Results: Statistically significant differences were observed after applying the cognitive stimulation treatment in the perceptive reasoning index of the WISC-IV. No differences were obtained on the Conners' and the BRIEF scores before and after the treatment. Neither were any differences found in the results on the WISC-IV according to sex or on the GMFCS., Conclusions: The cognitive performance of children with cerebral palsy improves after applying a cognitive rehabilitation programme.

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.

Introduction: Persons who have suffered brain damage can experience a wide range of cognitive, behavioural and emotional disorders. However, neuropsychological rehabilitation usually focuses, almost exclusively, on the cognitive deficits and pays very little attention to the emotional challenges associated with the psychological impact of the lesion. It is in this more personal side of brain damage where neuropsychotherapy can be of great aid to facilitate the process of acceptance and adaptation following a neurological lesion., Development: In this article, we describe the theoretical and conceptual aspects of psychotherapy oriented towards persons with brain damage, the implications of cognitive deficits in the practice of neuropsychotherapy and the evidence regarding its effectiveness., Conclusions: In the past, neuropsychotherapy was considered to be of little use in the rehabilitation of brain damage. Today, however, a growing number of professionals are acknowledging its importance in the management of the psychological/emotional suffering associated with brain damage. The aim of neuropsychological rehabilitation is not just to promote the recovery of the altered brain functions, but also to improve the individual's functional capacity, deal with his or her experiences of loss and help him or her to again find a meaning to life.

Introduction: The decrease in the rate of mortality due to brain damage during the First World War resulted in a large number of veterans with neurological or neuropsychological sequelae. This situation, which was unknown up until then, called for the development of new therapeutic approaches to help them reach acceptable levels of autonomy., Development: This article reviews the relationship between neuropsychological rehabilitation and warfare, and describes the contributions made by different professionals in this field in the two great conflicts of the 20th century. The First World War was to mark the beginning of neuropsychological rehabilitation as we know it today. Some of the most outstanding contributions in that period were those made by Goldstein and Popplereuter in Germany or Franz in the United States. The Second World War was to consolidate this healthcare discipline, the leading figures at that time being Zangwill in England and Luria in the Soviet Union. Despite being of less importance, geopolitically speaking, the study also includes the Yom Kippur War, which exemplifies how warfare can stimulate the development of neuropsychological intervention programmes., Conclusions: Today's neuropsychological rehabilitation programmes are closely linked to the interventions used in wartime by Goldstein, Zangwill or Luria. The means employed may have changed, but the aims are still the same, i.e. to help people with brain damage manage to adapt to their new lives.

Background and Objective: The aim of this study was to examine the effect of cognitive reserve in recovery after a moderate or severe traumatic brain injury (TBI). Different authors proposed that this construct might account for the mismatch between TBI severity, its clinical expression, and subsequent recovery., Patients and Method: Eighty-four patients who sustained moderate-to-severe TBI participated in the study. Participants were divided into a high cognitive reserve group (n=46) or low cognitive reserve group (n=38) based on premorbid educational and occupational attainment. Patient's functional status was examined with the Patient Competency Rating Scale (PCRS)., Results: There were no significant differences between groups in demographic and injury variables (sex, age, severity of injury, post-traumatic amnesia duration, and time since injury). The analysis revealed statistically significant differences between the 2 groups on the PCRS: The high cognitive reserve group scored better than the low cognitive reserve group., Conclusions: The results of this study suggest that cognitive reserve may mediate recovery after a moderate or severe TBI. Educational and occupational attainments provide a cognitive provision that would be associated with better functional status after injury., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

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.

Executive functions are critical in our daily life. People with traumatic brain injury (TBI) often have difficulty functioning appropriately in everyday life. The objective of this study was to investigate the relationship between executive function and functional capacity after TBI. The sample consisted of 43 moderate or severe TBI patients (mean age: 32 years, SD= 13.9). All participants were tested with a battery of executive function measures (Trail Making Test-B, Wisconsin Card Sorting Test, Letter-Number Sequencing of the WAIS-III, Stroop Color-Word Interference Test, and Controlled Oral Word Association Test). Patients' everyday functioning was examined with the Patient Competency Rating Scale (PCRS). PCRS was correlated significantly, although moderately, with Trail Making Test-B, Letter-Number Sequencing, and Controlled Oral Word Association Test. These findings suggest that executive function measures used in clinical practice reveal some degree of ecological validity, providing relevant information for predicting daily-life functioning after moderate to severe TBI.

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.

Introduction: The first five years of life are critical in the development of the executive functions. The changes that are seen to take place in executive competence and capacity are closely related to the maturational processes of the prefrontal cortex., Development: Evidence gathered over the past three decades indicates that executive functioning begins to develop earlier than was previously believed. At early ages it is possible to observe the appearance of different cognitive capacities that will later make up what we call the executive functions. The purpose of this article is to describe how the executive functions develop over the first five years of life and their relationship with the maturation of the prefrontal cortex., Conclusions: The development of the executive functions involves the development of a series of cognitive capacities that have to enable the child to retain and manipulate information and to act accordingly; to self-regulate their behaviour so that they can act in a reflexive rather than impulsive manner; and to adapt their behaviour to fit the changes that can occur in the surroundings. Early upsets in executive development have a drastic restricting effect on the child's capacity to cope with novel situations, as well as to have the flexibility required to adapt to changes with ease.

Introduction: Patients with multiple sclerosis (MS) may have an impairment in their decision-making. Altered decision making is a known cause of functional impairment in daily living activities and in the patient's autonomy, negatively contributing to their quality of life., Objective: The current study assessed the decision-making capacity of patients with primary progressive multiple sclerosis (PPMS) and secondary progressive multiple sclerosis (SPMS) compared to healthy control subjects., Patients and Methods: Nineteen patients with multiple sclerosis (9 PPMS and 10 SPMS) and 18 healthy controls participated in the study. Decision-making was evaluated using a computerized version of the Iowa Gambling Task (IGT), a test created to simulate punishment-reward contingencies in a real-life manner., Results: Overall, the PPMS group performed more poorly than the control and SPMS groups on the IGT. The SPMS group was not significantly impaired compared to control group on the task, but showed abnormalities of IGT performance similar to the PPMS group., Conclusions: The authors suggest that the existence of decision- making impairments in patients with multiple sclerosis can be explained by a difficulty in the acquisition of stimulus-reward contingencies.

Cognitive dysfunction has been widely studied in multiple sclerosis (MS), however decision-making has been less investigated. The current study examined the decision-making processes of patients with multiple sclerosis (MS) using a computerized version of the Iowa Gambling Task (IGT). This task was applied to 18 patients with clinically diagnosed MS and 18 healthy control subjects matched for age, sex, and years of education. The results showed that IGT scores differ significantly between patients with MS and the healthy control subjects: the patients with MS made significantly less advantageous decisions than the controls in the IGT. Possible causes of impaired decision-making in multiple sclerosis are discussed.

Introduction: Current models of the executive functions enable us to state that this construct embraces a large number of processes and sub processes that are in turn linked to different regions of the brain, and more specifically to the prefrontal cortex. Recent data suggest that different areas of the prefrontal cortex may be involved in a number of aspects related to executive functioning., Development: The aim of this article is to review the most important models of executive functioning in order to shed light on this controversial construct. The models put forward to date approach the same reality from a number of different perspectives, although in some cases they neglect certain parts of that reality. In this second part of our paper, we review the dynamic filter theory, the differential axes model, the theory of cognitive complexity and control, the theory of hierarchical representation, the attentional control model, the supervisory attentional system and the input hypothesis., Conclusions: From the results obtained in the studies that were reviewed we can state that it is possible to divide the 'executive functions' construct into sub processes in order to make understanding, assessment and intervention easier. Each of these sub processes seems to be related to a specific area in the prefrontal cortex, although a particular region can be involved in different aspects of executive functioning at different moments in time.

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.

Purpose: Develop a classificatory tool to identify different populations of patients with Traumatic Brain Injury based on the characteristics of deficit and response to treatment., Work Method: A KDD framework where first, descriptive statistics of every variable was done, data cleaning and selection of relevant variables. Then data was mined using a generalization of Clustering based on rules (CIBR), an hybrid AI and Statistics technique which combines inductive learning (AI) and clustering (Statistics). A prior Knowledge Base (KB) is considered to properly bias the clustering; semantic constraints implied by the KB hold in final clusters, guaranteeing interpretability of the resultis. A generalization (Exogenous Clustering based on rules, ECIBR) is presented, allowing to define the KB in terms of variables which will not be considered in the clustering process itself, to get more flexibility. Several tools as Class panel graph are introduced in the methodology to assist final interpretation., Work Results: A set of 5 classes was recommended by the system and interpretation permitted profiles labeling. From the medical point of view, composition of classes is well corresponding with different patterns of increasing level of response to rehabilitation treatments., Discussion: All the patients initially assessable conform a single group. Severe impaired patients are subdivided in four profiles which clearly distinct response patterns. Particularly interesting the partial response profile, where patients could not improve executive functions., Conclusions: Meaningful classes were obtained and, from a semantics point of view, the results were sensibly improved regarding classical clustering, according to our opinion that hybrid AI & Stats techniques are more powerful for KDD than pure ones.

Introduction: Patients with moderate or severe traumatic brain injury (TBI) may show impairment in decision- making processes. The Iowa Gambling Task (IGT) has become a widely used neuropsychological research tool to investigate decision-making by simulating real-life decision-making in terms of uncertainty, reward, and punishment., Objective: Investigate decision-making in patients with moderate or severe TBI during performance of the IGT, and study patient's conscious knowledge of the task's reinforcement contingencies (reward/punishment schedule)., Patients and Methods: Forty patients with moderate or severe TBI and 30 healthy volunteers participated in the study. Decision-making was evaluated using a computerized version of the IGT. After completing the task, the participants' knowledge of the task was tested., Results: The TBI group had worse performance on the IGT than the control group. They chose more unfavorable cards of the deck than the favorable ones. IGT score differences were observed among TBI patients in relation to level of knowledge of the task. The patients with knowledge of the task's reinforcement contingencies showed better performance, while the patients with scarce knowledge presented worse performance., Conclusions: These results suggest that there is a direct relationship between the knowledge that patients with moderate and serious TBI have regarding the TBI reinforcement contingencies and their performance in the task.

A 47-year-old man with a left temporo-occipital infarct in the area of the posterior cerebral artery is presented. The neuropsychological examination did not reveal aphasia or gross mental deficits. The patient presented with alexia without agraphia, color agnosia, but few visual perceptual deficits. The main impairment was in confrontation naming; he was incapable of naming objects and pictures, not from lack of recognition (excluding visual agnosia) but from lack of access to the appropriate word (optic aphasia). The patient also exhibited a deficit in the evocation of gesture from the visual presentation of an object (optic apraxia) and a difficulty in "conjuring up" visual images of objects (impaired visual imagery) and loss of dreams. The fundamental deficit of this patient is tentatively explained in terms of visuoverbal and visuogestural disconnection and a deficit of mental imagery.