Maria Pachalska

Evaluation of differentiated neurotherapy programs for a patient after severe TBI and long term coma using event-related potentials

Summary Background This article examines the effectiveness of differentiated rehabilitation programs for a patient with frontal syndrome after severe TBI and long-term coma. We hypothesized that there would be a small response to relative beta training, and a good response to rTMS, applied to regulate the dynamics of brain function. Case Report M. L-S, age 26, suffered from anosognosia, executive dysfunction, and behavioral changes, after a skiing accident and prolonged coma, rendering him unable to function independently in many situations of everyday life. Only slight progress was made after traditional rehabilitation. The patient took part in 20 sessions of relative beta training (program A) and later in 20 sessions of rTMS (program B); both programs were combined with behavioral training. We used standardized neuropsychological testing, as well as ERPs before the experiment, after the completion of program A, and again after the completion of program B. As hypothesized, patient M.L-S showed small improvements in executive dysfunction and behavioral disorders after the conclusion of program A, and major improvement after program B. Similarly, in physiological changes the patient showed small improvement after relative beta training and a significant improvement of the P300 NOGO component after the rTMS program. Conclusions The rTMS program produced larger physiological and behavioral changes than did relative beta training. A combination of different neurotherapeutical approaches (such as neurofeedback, rTMS, tDCS) can be suggested for similar severe cases of TBI. ERPs can be used to assess functional brain changes induced by neurotherapeutical programs.

Evaluation of neurotherapy for a patient with chronic impaired self-awareness and secondary ADHD after severe TBI and long term coma using event-related potentials

We examined the effectiveness of neurotherapy for chronic, impaired self-awareness and secondary ADHD (SADHD) diagnosed in the patient after severe TBI. We hypothesized a good response to relative beta training. Patient A.A., age 30, after severe TBI and long-term coma, suffered from chronic, impaired self-awareness and SADHD, manifesting two years post trauma. Only slight progress was made after behavioral training. The patient took part in a neurotherapy program consisting of 40 sessions of relative beta training. We used standardized neuropsychological testing, as well as ERPs before and after the completion of neurotherapy. Background:

Neuropsychiatric symptoms in patients with Alzheimer's disease with a vascular component

OBJECTIVE Vascular changes are observed in most cases of Alzheimers disease (AD). Observations of AD and vascular disease (VD) allow us to surmise that vascular changes may not only affect cognitive impairment in AD but may also have a negative influence on the neuropsychiatric symptoms which often occur in the course of the disease. The aim of the study was to evaluate the impact of vascular factors on the neuropsychiatric symptoms in Alzheimers Disease. MATERIAL AND METHODS The study included 48 people with a preliminary diagnosis of Alzheimers Disease on the basis of NINCDS/ADRDA criteria. The evaluation of impairments in cognitive functioning was carried out by means of the Alzheimer Disease Assessment Scale - the cognitive part (ADAS - cog), whereas the behavioural and psychological symptoms were evaluated by means of the Neuropsychiatric Inventory - the version adapted for residents of nursing homes for the elderly (Neuropsychiatric Inventory - Nursing Home Version) (NPI - NH). The score on the Hachinski scale was the basis for dividing the study participants into two groups - those with a mild vascular component (0-1 points on the Hachinski scale) and those with a severe vascular component (2-4 points). RESULTS The analyzed groups did not differ with respect to the intensity of cognitive impairments (ADAS-cog) or age of the participants. Scores obtained on the NPI - NH scale as well as some of its elements (depression/dysphoria and anxiety) had a discriminating value. Studies show that vascular factors are a serious risk factor for neuropsychiatric symptoms in AD. CONCLUSIONS Vascular factors in Alzheimers Disease influence the presence of neuropsychiatric symptoms. In the course of angiogenic dementia a greater frequency in depressive disorders was shown. The most visible differences between individuals with a greater and lesser burden of vascular factors was in the realm of depressive and dysphoric disorders.

A case of "borrowed identity syndrome" after severe traumatic brain injury.

Summary Background It is well known that traumatic brain injury often changes the way the patient perceives reality, which often means a distortion of the perception of self and the world. The purpose of this article is to understand the processes of identity change after traumatic brain injury. Case Report We describe progressive deterioration in personal identity in a former physician who had sustained a serious head injury (1998), resulting in focal injuries to the right frontal and temporal areas. He regained consciousness after 63 days in coma and 98 days of post-traumatic amnesia, but has since displayed a persistent loss of autobiographical memory, self-image, and emotional bonds to family and significant others. Qualitative ‘life-story’ interviewing was undertaken to explore the mental state of a patient whose subjective, “first person” identity has been disengaged, despite the retention of significant amounts of objective, “third person” information about himself and his personal history (though this was also lost at a later stage in the patient’s deterioration). Identity change in our patient was characterized by a dynamic and convoluted process of contraction, expansion and tentative balance. Our patient tends to cling to the self of others, borrowing their identities at least for the period he is able to remember. Identity is closely connected with the processes of memory. Conclusions The results will be examined in relation to the microgenetic theory of brain function. The brain mechanisms that may account for these impairments are discussed. Findings from this study have important implications for the delivery of person-focused rehabilitation.

Differential diagnosis of behavioral variant of fronto-temporal dementia (bvFTD)

Summary Background The aim of the paper is the differential diagnosis of various types of Fronto-Temporal Dementia (FTD), with the focus on its behavioural variant (bvFTD). Material/Method Material and Method. Screening was done in order to assess the depth of dementia with the short version of MMSE, while evaluation of various variants of FTD was performed with the use of such neuropsychological tests as Newcomb and Chicago Fluency Tests, Wechsler Memory Scale - III (WMS-III), Western Aphasia Battery (WAB-R), and the Boston Naming Test (BNT). Behaviour was evaluated with a Polish version of the Frontal Behavioral Inventory (FBInv). The inventory consists of 24 questions which enable an evaluation of social behaviour disorders. The study included 112 patients - 68 men and 46 women treated in the Reintegrative -Training Centre of the Foundation for Persons with Brain Dysfunctions in Kraków and in the Clinic for Developmental Psychiatry, Psychotic Disorders and Old Age Psychiatry, of the Medical University at Gdańsk, who were suffering from various types of dementia. Results It was found that FTD patients scored the highest, while the VAD patients scored somewhat lower in the FBInv. At the same time the scores obtained by PPA patients were higher in comparison to the control groups, but not as high as in the case of patients with FTD. In the process of the neurotherapy of FTD patients we found a reduction of the behavioral disturbances, despite the progression of the illness. Conclusions The results obtained in the present study confirmed the diagnostic value of FBInv in the differential diagnosis of various types of FTD and in the evaluation of neurotherapy efficacy.

Reintegrating space and object representations in patients with hemispatial neglect: two case studies

Purpose: This article examines the effectiveness of differentiated rehabilitation programmes for patients with two distinct types of hemispatial neglect: body-centred and object-focused. We hypothesized that patients with body-centred neglect would respond to motor-control programmes designed for patients with limb apraxia, while those with object-focused neglect would require visually oriented therapy. Material and methods: The article describes the rehabilitation of two patients treated by the authors 6 – 9 months after right-hemisphere infarct. Both showed significant left-sided hemispatial neglect: body-centred in one case (patient BC), object-focused in the other (patient OF). A modified AB – BA experimental design was used, where A represents visual training, and B is spatio-motor training. For patient BC, the sequence was A – B; for patient OF, B – A. Neglect was measured using standard tests for neglect and the analysis of drawings made during therapy by both patients. Results: As hypothesized, patient BC showed no progress after conclusion of programme A, while after programme B she showed virtually no lingering neglect. In the case of patient OF, the results were exactly reversed. Conclusions:  Body-centred neglect is essentially a defect in space formation, while object-focused neglect is a disorder of object formation. The patients described here both benefited from neuropsychological therapy for neglect, but not from the same programme.

Application of ERPs neuromarkers for assessment and treatment of a patient with chronic crossed aphasia after severe TBI and long-term coma – Case Report

Objective. The study aimed to evaluate the application of ERPs neuromarkers for the assessment and treatment of a patient with chronic crossed aphasia after severe TBI and a long-term coma. CASE REPORT An ambidextrous female patient, aged 29, suffered from posttraumatic chronic crossed aphasia, severe TBI and a prolonged coma after a car accident. The patient took part in two differentiated rehabilitation programmes of neurotherapy included 20 sessions of relative beta training and 20 sessions of rTMS; both programmes were combined with behavioural training. The patient was tested 3 times: before the experiment, after completion of programme A, and after completion of programme B. RESULTS In the 1st recording, the neuromarker of aphasia was found - an excess of the P2 wave over the left temporal area. There was a cognitive control deficit - an excess of omission errors and an increase of RT variability - all indexes of sporadic ADHD. In the 2nd recording, slight improvements in cognitive control, and language functions were found. In the 3rd recording, after the rTMS sessions most of her cognitive dysfunctions had been resolved, including language functions. It should be stressed that the activation (especially the increase in the ERP potential of the right side over the frontal lobe) was found. The neuromarker of aphasia did not change, only the location had slightly moved frontally. CONCLUSIONS The application of ERP neuromarkers assists in the diagnosis, treatment, and academic success of an ambidextrous patient with chronic posttraumatic aphasia and sporadic ADHD. ERPs can be used to assess the functional brain changes induced by neurotherapeutical programmes.

CREATIVE POTENTIAL OF MICROGENETIC THEORY

This paper is devoted to illustrating how process neuropsychology and neurolinguistics, based on microgenetic theory and rooted in process thought, can help to explain the often baffling symptomatology of brain damage. Our purpose is to present an overview of this difficult and complex subject matter for readers, with particular emphasis on its creative potential. The essence of microgenetic theory in neuro psy chology is an account of the phases in brain process through which successive mind/brain states arise and perish over the duration of the psychological present, measured in milliseconds. According to the theory, mental states are rhythmically generated out of a “core” in the anatomically deepest and phylogenetically oldest parts of the central nervous system, over phases to the outermost and youngest regions of the brain, the neocortex. The clinical applications are only one aspect of the creative potential of microgenetic theory. Indeed, the elegance of the theory consists in the way in which it can be extended into a number of different fields of endeavor, providing a kind of “unified field theory” for the explanation of often rather diverse phenomena. This provides an opportunity for neuropsychology and neurolinguistics to resume the interdisciplinary discourse they were founded to conduct.

APPLICATION OF FUNCTIONAL NEUROMARKERS FOR CONSTRUCTING PROTOCOLS OF NEUROTHERAPY AND MONITORING THE SUCCESS OF TREATMENT IN CHRONIC CROSSED TRANSCORTICAL SENSORY APHASIA: A CASE STUDY

The goal of the study was threefold: 1) to evaluate QEEG/ERPs in dexes of functional brain impairment after a stroke associated with chronic crossed transcortical sensory aphasia, 2) to construct a neu rotherapy protocol to compensate for this functional damage, and 3) to assess the changes in the functional neuromarkers induced by the neurotherapy sessions. A 72-year-old, strongly right-handed woman with atrial fibrillation sud denly developed cerebral embolism of the right middle cerebral artery. She was treated conservatively, and the left hemiparesis, and aphasia – in a moderate degree, consequently existed. A CT-scan showed a large infarct lesion partially parallel to Wernicke’s area. After one year of ineffective aphasia therapy we constructed an experimental neuro therapy protocol (TMS combined with comprehensive aphasia therapy) on the basis of an assessment of the spontaneous QEEG and eventrelated potentials (ERPs) in the cued GO/NOGO. The patient was assessed before and after the neurotherapy sessions by the same methodology. It was found that before the TMS treatment the temporal area (T6) generates a strong P2 wave in response to visual stimulus indicating a hyper-sensitivity of the neurons located at temporal areas of the right hemisphere. This was connected with crossed transcortical sensory aphasia found within the aphasia profile in the Polish version of the Western Aphasia Battery (K-WAB). The TMS sessions reduced this hypersensitivity substantially. The patient speech returned to the norm, she was to return to social life.

Assessment of personality changes in dementia of the Alzheimer's type and frontotemporal dementia

Background Personality changes occur in the course of many dementive illnesses, in addition to disturbances of cognitive processes. In the literature, however, there is no model that would explain the nature, direction, and dynamics of these changes. Cognitive deterioration in these patients is accompanied by loss of insight regarding personality changes. This is the reason why the majority of methods available on the market to study personality, though highly accurate and reliable, are not suitable for the evaluation of these changes. The purpose of this research was to describe the nature, direction, and dynamics of personality changes in persons with a clinical diagnosis of dementia of the Alzheimer type (DAT) and fronto-temporal dementia (FTD).