Silvia Adriana Prado Bolognani

Subtle cognitive deficits in adults with a previous history of Sydenham's chorea during childhood.

To evaluate the neuropsychological profile and health‐related quality of life (HRQOL) of adults who had rheumatic fever (RF) during childhood with and without Sydenhams chorea (SC).

Procedures to improve daily activities performance in individuals with cerebral anoxia: case report

OBJECTIVE To present a rehabilitation case study; procedures to improve the performance on daily activities were used by the caregiver. PATIENT Cerebral anoxia due to cardiac arrest. He presented memory deficits for both visual and verbal material, temporal disorientation, abulia, psychomotor slowing and bradypsychism. METHODS daily activities were developed in fixed hours; calendar was presented 3 times a day; daily walks were performed; self-care activities were performed by the patient with short verbal commands and cues from the caregiver. RESULTS We observed improvement on initiative and autonomy for daily activities, attention, temporal orientation and bradypsychism. There was also reduction on response time. CONCLUSIONS Behavioral control strategies result on improvement for patients and their family although limit their routine. Behavioral control strategy promotes learning through the preserved implicit memory mechanism and results on enhancement at patients autonomy at home.

Memória implícita e sua contribuição à reabilitação de um paciente amnéstico: relato de caso

Even severe amnesic patients usually are able to learn new information using implicit memory strategies. In the present study we describe our experience in the rehabilitation of an amnesic patient who had suffered cerebral anoxia. He was taught to use a computer text editor, enabling him to sheltered work. The training program lasted 14 weeks and was based on errorless learning and drilling practice techniques. The patient succeeded in all tasks, even though he could not remember accurately the training sessions. These results meet previous studies which point out that interaction between implicit and residual explicit memory can provide a basis new learning in amnesic patients. The domain-specific knowledge acquisition is demonstrating effectiveness in neuropsychological rehabilitation of brain injured patients.Mesmo pacientes severamente amnesticos sao capazes de aprender informacoes novas, apoiados em estrategias de memoria implicita. No presente estudo descrevemos uma experiencia de reabilitacao neuropsicologica, em que um paciente amnestico, portador de lesao cerebral por anoxia, foi submetido a treino para uso de computador, visando sua capacitacao semi-profissional. O treinamento teve duracao de 14 semanas, e as tecnicas de ensino utilizadas foram a pratica repetitiva e a aprendizagem sem erros. O paciente obteve sucesso na realizacao das tarefas propostas, aprendendo a operar um editor de textos e mantendo o aprendizado apos a passagem do tempo. Apesar disso, lembrava-se apenas vagamente da situacao de aprendizagem. O presente estudo corrobora trabalhos anteriores que observam a interacao entre mecanismos de memoria implicita e residuos de memoria explicita operando na aquisicao de conhecimentos em pacientes amnesticos. A aprendizagem de conhecimentos especificos vem se mostrando eficiente para a reabilitacao de pacientes que sofreram lesoes cerebrais.

Versões Alternativas do Subteste Memória Lógica da WMS-R: Análise de Desempenho de uma Amostra Saudável da Cidade de São Paulo

O teste Memoria Logica da Wechsler Memory Scale - Revised (WMS-R) e amplamente utilizado na pratica clinica como instrumento de avaliacao da memoria verbal. O objetivo deste estudo foi analisar as propriedades psicometricas iniciais de versoes alternativas das historias traduzidas e livremente adaptadas da WMS-R empregadas no Brasil: tres historias equiparaveis a historia Ana Soares e tres a de Roberto Mota. A amostra foi constituida de 655 universitarios, com idades entre 18 e 35 anos. Foi solicitada a recordacao livre imediata e tardia (apos 30 min) de cada historia, original e alternativas. A analise de equivalencia entre a recordacao imediata e tardia das historias alternativas e originais mostrou que cinco historias foram memorizadas de forma equiparavel as historias originais se aplicadas individualmente. A recordacao de tres pares dessas historias alternativas tambem foi equivalente a recordacao do par original. Uma analise utilizando a Teoria de Resposta ao Item apontou os itens com melhor indice discriminativo. Assim, propoe-se historias alternativas as do WMS-R que poderao ser usadas em estudos de normatizacao.

Development of alternative versions of the Logical Memory subtest of the WMS-R for use in Brazil

The logical memory test of the Wechsler Memory Scale is one of the most frequently used standardized tests for assessing verbal memory and consists of two separate short stories each containing 25 idea units. Problems with practice effects arise with re-testing a patient, as these stories may be remembered from previous assessments. Therefore, alternative versions of the test stimuli should be developed to minimize learning effects when repeated testing is required for longitudinal evaluations of patients. Objective To present three alternative stories for each of the original stories frequently used in Brazil (Ana Soares and Roberto Mota) and to show their similarity in terms of content, structure and linguistic characteristics. Methods The alternative stories were developed according to the following criteria: overall structure or thematic content (presentation of the character, conflict, aggravation or complements and resolution); specific structure (sex of the character, location and occupation, details of what happened); formal structure (number of words, characters, verbs and nouns); and readability. Results The alternative stories and scoring criteria are presented in comparison to the original WMS stories (Brazilian version). Conclusion The alternative stories presented here correspond well thematically and structurally to the Brazilian versions of the original stories.

Developmental prosopagnosia and adaptative compensatory strategies: Case study

Prosopagnosia is a type of visual agnosia with inability to identify faces, usually secondary to brain lesion in associative cortex areas, but there is also a congenital form known as developmental prosopagnosia. Objectives To describe a case of developmental prosopagnosia that illustrates the specificity of the pathways for perception of faces in the visual system. Also, we will describe possible mechanisms of recognition used by this patient. Methods R.S., a 50 year-old woman, was referred for neuropsychological assessment due to difficulties in perception of familiar faces since childhood, unexplained by any loss of visual acuity. Results The exam showed good performance for comprehension, reasoning, concept formation, constructional abilities, criticism, judgment, mental control, memory and visual perception for other kinds of stimuli. No difficulties were seen regarding identification of ethnicity, age and types of animals. The patient was able to match celebrities’ faces in different positions, but could not identify the matching pictures for unknown people. Conclusions These findings indicate the patient had developed strategies, throughout life, to recognize familiar faces (relatives, celebrities) from memorized fragments, but still had difficulties in identifying non-familiar faces holistically.

Neuropsychological rehabilitation in a patient with ruptured anterior communicating artery aneurysm. 48 month outcomes

The neurobehavioral impairments associated with aneurysms of the anterior communicating artery (ACoA) are severe amnesia, executive problems and personality changes. Although most patients achieve a favorable neurological outcome, those cognitive deficits usually prevent return to previous activities and levels of social integration. Objectives To report the outcomes of a neuropsychological and behavioral intervention in a 55 year-old man with very severe memory and executive dysfunctions following ACoA aneurysm rupture. Methods Neuropsychological intervention focused in functional adjustment in everyday life was used, including individual sessions with the patient, discussion sessions with caregivers and also work with patient at home, aiming generalization of the rehabilitation strategies. Neuropsychological and functional assessments were conducted pre and post intervention. Results Important improvements were seeing in behavior and daily living performance after treatment. Conclusions A neuropsychological rehabilitation approach focused on goals based on the family and caregivers necessities is an efficient manner in which to carry out cognitive rehabilitation in severe cases. The importance of a supportive family should be stressed.