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Interventions in Stroke-Evidence based managementDr Vipul Gupta
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2. Recent clinical trials provide strong evidence that endovascular thrombectomy within 6 hours of stroke onset is effective for appropriately selected patients with large vessel occlusions. This represents a dramatic change in the management of acute ischemic stroke.
3. The document also reviews management of aneurysms, vasospasm post-subarachnoid hemorrhage, and carotid artery stenosis, highlighting the shift to predominantly endovascular approaches.
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2. Revascularization can be direct, using vessel to vessel anastomoses, or indirect, promoting new capillary formation. Direct techniques provide immediate flow but require a recipient vessel over 1mm, while indirect revascularization relies on collateral formation.
3. Common indications for revascularization include moyamoya disease, complex aneurysms, skull base tumors, and cerebral ischemia. However, recent studies found no benefit for revascularization over medical management for treating ischemia.
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- Using bedside tests to evaluate attention, memory, language, reasoning, affect, and hemispheric dominance.
- Attention should be assessed systematically starting from level of consciousness to directed attention and cognition.
- Thorough history taking and observation of patient behavior during examination provides important information.
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2. Recent clinical trials provide strong evidence that endovascular thrombectomy within 6 hours of stroke onset is effective for appropriately selected patients with large vessel occlusions. This represents a dramatic change in the management of acute ischemic stroke.
3. The document also reviews management of aneurysms, vasospasm post-subarachnoid hemorrhage, and carotid artery stenosis, highlighting the shift to predominantly endovascular approaches.
The document discusses frontal subcortical circuits and their assessment. It describes the five main frontal-subcortical circuits, including the motor circuit, oculomotor circuit, dorsolateral prefrontal circuit, anterior cingulate circuit, and orbitofrontal circuit. It then examines each circuit in more detail, outlining their anatomical components and behavioral syndromes associated with dysfunction. A number of bedside assessment tests are also presented to help evaluate specific circuits.
1. The history of cerebral revascularization began in 1942 with various techniques being developed through the 1970s including EDAMS, CCA-ICA bypass, and STA-MCA bypass.
2. Revascularization can be direct, using vessel to vessel anastomoses, or indirect, promoting new capillary formation. Direct techniques provide immediate flow but require a recipient vessel over 1mm, while indirect revascularization relies on collateral formation.
3. Common indications for revascularization include moyamoya disease, complex aneurysms, skull base tumors, and cerebral ischemia. However, recent studies found no benefit for revascularization over medical management for treating ischemia.
This document provides guidelines for the diagnosis and treatment of multiple sclerosis (MS). It discusses the different subtypes of MS, diagnostic criteria, disease mechanisms, epidemiology in India, clinical features of relapses, and guidelines for using disease-modifying therapies. Key recommendations include using McDonald criteria for diagnosis, treating relapsing forms of MS with approved disease-modifying drugs, monitoring patients on treatment, and considering ocrelizumab for primary progressive MS.
Examination of mental functions by Dr. Pandian M.Pandian M
The document discusses examination of higher cerebral functions including:
- Performing standardized tests like the Mini-Mental State Examination to assess cognition, attention, memory, and mood.
- Using bedside tests to evaluate attention, memory, language, reasoning, affect, and hemispheric dominance.
- Attention should be assessed systematically starting from level of consciousness to directed attention and cognition.
- Thorough history taking and observation of patient behavior during examination provides important information.
The document outlines 7 essential career tools that every professional needs, as presented by J.T. O'Donnell, CEO of CareerHMO.com. The 7 tools are: 1) a personal brand statement, 2) a career story, 3) an updated resume, 4) a keyword optimized LinkedIn profile, 5) an updated cover letter format, 6) interview preparation, and 7) an interview bucket list. The document encourages the reader to assess if they have these tools and offers a risk-free 30-day trial for CareerHMO.com's paid memberships, which include reviews and assessments of these career marketing materials.
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Dokumen tersebut merupakan pedoman pelaksanaan Olimpiade Akuntansi yang diselenggarakan oleh Himpunan Mahasiswa Jurusan Akuntansi Universitas Islam Negeri Maulana Malik Ibrahim Malang. Olimpiade ini terdiri dari 3 babak yaitu babak penyisihan, semi final, dan final yang bertujuan untuk mengembangkan minat siswa SMA/SMK dalam bidang akuntansi.
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1. Daniel and his friends fasted from the king's food and wine at Babylon for 10 days to test if a vegetarian diet from God would make them healthier.
2. God blessed their acceptable fasting with godly character, 10 times better understanding than magicians, good health, and success before the king.
3. The Daniel Fast involves 3 levels - sheep (no meat/soft drinks), deer (half usual rice intake), and lion (veggies/fruits only). Our 90DC fasting is March 1-30 to fast for our 12 habits success, personal requests, and conquest.
This document discusses the nature of love according to God. It states that God is love, and that in order to become like God, people cannot separate what love "is" and what it "does." It provides many Bible verses that define love, such as having patience and kindness, not being jealous or boastful, and protecting, trusting, and hoping in others. It emphasizes that love is the fulfillment of God's commandments and that Christians are called to love God, their neighbors, and themselves.
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A presentation originally created in 2006, and updated in 2014 with 8 NEW SLIDES and tips on how to promote, market and distribute your content marketing online.
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The document discusses 12 business lessons learned from the Obama presidential campaign's effective use of digital and social media. It summarizes key tactics the campaign used, such as maintaining a centralized customer database, using social networks to leverage large audiences, engaging supporters through YouTube videos, targeting small online donations, self-managed social networks, mobile applications, Twitter, blogging, and capturing consumer information. The outcomes included hundreds of thousands of organized events and donors, millions of calls and donations made, and over $500 million raised online and $639 million total.
The document outlines 7 essential career tools that every professional needs, as presented by J.T. O'Donnell, CEO of CareerHMO.com. The 7 tools are: 1) a personal brand statement, 2) a career story, 3) an updated resume, 4) a keyword optimized LinkedIn profile, 5) an updated cover letter format, 6) interview preparation, and 7) an interview bucket list. The document encourages the reader to assess if they have these tools and offers a risk-free 30-day trial for CareerHMO.com's paid memberships, which include reviews and assessments of these career marketing materials.
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Sarfudheen is seeking a challenging role in welding and quality control with over 5 years of experience. He has a Bachelor's degree in Mechanical Engineering and is a certified welding inspector by CSWIP and ASNT. He has worked on projects in India, Saudi Arabia, and UAE, performing tasks like materials inspection, welding inspection, and ensuring quality standards are followed. He is knowledgeable in codes like ASME, AWS, and has experience with AutoCAD, Solidworks, and MS Office.
The document discusses a life buoy shooting unit (LSU01) that is designed to store and launch lifebuoys and smoke pots from ships. The LSU01 can be activated from the bridge or nearby and will shoot the lifebuoy meters away from the ship to save time during man overboard situations. It allows lifebuoys to be placed out of sight within the ship's bulwark. The LSU01 is designed for easy installation, loading, and unloading, and uses durable 316L stainless steel and composite materials. It can also have a lightweight composite hatch and hinges for easier interfacing with the vessel. The LSU01 works on compressed air and has an accumulator for safety in case the
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Dokumen tersebut merupakan pedoman pelaksanaan Olimpiade Akuntansi yang diselenggarakan oleh Himpunan Mahasiswa Jurusan Akuntansi Universitas Islam Negeri Maulana Malik Ibrahim Malang. Olimpiade ini terdiri dari 3 babak yaitu babak penyisihan, semi final, dan final yang bertujuan untuk mengembangkan minat siswa SMA/SMK dalam bidang akuntansi.
Feb.21.2016 -Sunday Message - Fasting the Daniel WayCatherine Lirio
1. Daniel and his friends fasted from the king's food and wine at Babylon for 10 days to test if a vegetarian diet from God would make them healthier.
2. God blessed their acceptable fasting with godly character, 10 times better understanding than magicians, good health, and success before the king.
3. The Daniel Fast involves 3 levels - sheep (no meat/soft drinks), deer (half usual rice intake), and lion (veggies/fruits only). Our 90DC fasting is March 1-30 to fast for our 12 habits success, personal requests, and conquest.
This document discusses the nature of love according to God. It states that God is love, and that in order to become like God, people cannot separate what love "is" and what it "does." It provides many Bible verses that define love, such as having patience and kindness, not being jealous or boastful, and protecting, trusting, and hoping in others. It emphasizes that love is the fulfillment of God's commandments and that Christians are called to love God, their neighbors, and themselves.
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Social Media Optimization: An Easy Guide to Marketing and Distributing Your C...Rohit Bhargava
A presentation originally created in 2006, and updated in 2014 with 8 NEW SLIDES and tips on how to promote, market and distribute your content marketing online.
A parallel is made between the responsibility of a victim when being rescued from the ocean and our responsibility when God is pulling us out of sin's grip.
How Obama Won Using Digital and Social MediaJames Burnes
The document discusses 12 business lessons learned from the Obama presidential campaign's effective use of digital and social media. It summarizes key tactics the campaign used, such as maintaining a centralized customer database, using social networks to leverage large audiences, engaging supporters through YouTube videos, targeting small online donations, self-managed social networks, mobile applications, Twitter, blogging, and capturing consumer information. The outcomes included hundreds of thousands of organized events and donors, millions of calls and donations made, and over $500 million raised online and $639 million total.
GIPS- Il Giornale Italiano di psicologia dello Sport, n° 20
http://www.calzetti-mariucci.it/shop/prodotti/gips-il-giornale-italiano-di-psicologia-dello-sport-n-20
L’ictus cerebrale è la terza causa di morte a livello mondiale e la seconda nel nostro Paese; nella fase acuta spesso provoca molteplici deficit cognitivi (Ferro JM, 2001) tali da influenzare negativamente la riabilitazione e il recupero del paziente, nonché la sua qualità di vita futura (Wade DT, 1992 ; Wade DT et al, 1986; Kalra L et al, 1997).
Una valutazione precoce permette pertanto la migliore definizione del percorso clinico assistenziale del paziente,determinando un importante indice predittivo dell’outcome a lungo termine (Nys G.M.S et al, 2005).
La valutazione del danno cognitivo, in questa fase, dovrebbe essere caratterizzata dall’utilizzo di test di screening bed-side veloci e di facile somministrazione, ma comunque in grado di rilevare la presenza dei deficit e la loro relativa entità.
In questa sede verrà descritto il ruolo dello psicologo-neuropsicologo all’interno della Stroke-Unit e saranno presentati alcuni risultati di una ricerca sperimentale volta all’identificazione precoce dei deficit cognitivi post-ictus.
L'approccio integrato al paziente demente: il ruolo della Nutrizione ClinicaASMaD
Presentazione a cura del Professor Evaristo Ettorre - XII° Congresso Nazionale FIMeG 2018 - The Silver Tsunami: l'anziano fra appropriatezza e farmaeconomia
1. Aspetti clinici e riabilitativi
dell’aprassia
Scuola di Specializzazione in Medicina Fisica e Riabilitazione
Università degli Studi di Verona
Nicola Smania
Servizio di Rieducazione Funzionale
Policlinico G.B. Rossi
Azienda Ospedaliera di Verona
2. Aprassia degli arti
E’ necessario escludere:
deficit sensitivo-motori
deterioramento intellettivo
scarsa comprensione verbale
scarsa collaborazione
Difficoltà o incapacità di eseguire gesti
su comando verbale o su imitazione
Il disturbo:
consegue frequentemente a
lesioni dell’emisfero sinistro
coinvolge entrambi gli arti sup.
3. SUBSTRATI ANATOMOFUNZIONALI DEL MOVIMENTO
VOLONTARIO
Leiguarda e Marsden, 2000
Circuiti parieto-frontali: integrazione sensorimotoria in “reaching” e grasping”
Sistemi fronto-striatali e fronto-parietali: sequenzialità delle azioni
Sistema temporoparietale-frontale: riconoscimento e imitazione delle azioni
4. Movimenti e gesti
Movimento Gesto
Parametri fisici
Normali
•Velocità
•Ampiezza
•Forza
•Etc
Patologici
•Bradicinesia
•Dismetria
•Ipostenia
•Etc
Contesto
Movimento
•Abduzione spalla
•Flessione gomito
•Dita estese e addotte
5. Aprassia Ideativa
• Esempi di errore gestuale:
1) il paziente non è in grado di pianificare
un’azione (es: tenta di versare l’acqua senza
aver tolto il tappo),
2) il gesto è inappropriato al contesto (es: il
paziente muove l’apribottiglie dentro al
bicchiere come se stesse mescolando)
• Ipotesi patogenetiche:
1) disturbo di conoscenza concettuale
riguardo l’uso di utensili o oggetti, 2) disturbo
di memoria semantica
Comunemente viene
diagnosticata richiedendo
l’uso di oggetti o utensili
6. Aprassia ideomotoria
• Esempi di errore gestuale:
1) distorsione spaziale, 2) configurazione
del gesto (orientamento), 3) scarsa
coordinazione tra diverse articolazioni,
4) errato “timing” del gesto (es.: eccessiva
lentezza)
• Ipotesi patogenetiche:
disturbo di “memoria motoria”
Comunemente viene
diagnosticata richiedendo di
effettuare gesti su imitazione
(il paziente, pur essendo in grado di pianificare l’azione,
esegue in maniera difettosa il programma motore)
7. Ricostruzione tridimensionale del movimento
durante il gesto di “affettare il pane”
Anomalie di movimento:
1. Caratteristiche spazio-temporali traiettoria
del polso (disaccoppiamento)
2. Coordinazione dei movimenti articolari
(> controllo prossimale)
3. Orientamento planare del movimento (non
orientato rispetto al corpo)
4. Profili di velocità delle traiettorie del polso
irregolari e non-sinusoidali
Le anomalie si verificano sia su comando
verbale che con l’uso di oggetti
8. Epidemiologia dell’aprassia degli arti
• L’aprassia ideativa è presente nel 28% dei cerebrolesi
sinistri e nel 13% dei destri (De Renzi et al, 1968)
• L’aprassia ideomotoria è presente nel 57% dei cerebrolesi
sinistri e nel 34% dei destri (Barbieri e De Renzi, 1988)
• L’aprassia ideomotoria persiste a 1 anno dall’ictus nel
45% dei pazienti (Basso et al, 1987)
9. Valutazione: aprassia ideativa e ideomotoria
• AI: Compiti di utilizzazione
(De Renzi e Lucchelli, 1988)
• AIM: imitazione gesti prossimali-distali,
simbolici-non simbolici
(De Renzi, Motti, Nichelli, 1980)
• Florida Apraxia Battery: gesti e
pantomime su comando verbale
(Rothi et al, 1992)
12. Aprassia e contesto
Il paziente che non è in grado di effettuare un
determinato gesto (es.: segno della croce)
durante il test può essere in grado di effettuarlo
in situazioni contestuali più facilitanti (es.:
entrando in chiesa)
DISSOCIAZIONE AUTOMATICO-VOLONTARIA
13. Dibattito su relazioni tra
“aprassia e disabilità” (1)
In situazioni contestuali Con l'uso di oggetti reali? Recupera spontaneamente
L'aprassia migliora
•Apraxia shows only under testing conditions. It does not prevent the patient from using
limb spontaneously…This makes therapy in most instances unnecessary (Poeck, 1985)
•Limb apraxia has been considered to be of theoretical and localising value rather than
practical significance (Basso et al, 1987)
•Apraxia has no independent negative influence on functional outcome (Pedersen et al,
2001)
14. Dibattito su relazioni tra
“aprassia e disabilità” (2)
• I pazienti aprassici richiedono maggior assistenza nelle ADL (Sundet et al,
1988)
• Paziente che usava utensili in maniera inappropriata nella vita di tutti i giorni
(Ochipa et al, 1989)
• L’aprassia ritarda il reinserimento al lavoro dei pazienti cerebrolesi (Saeki et
al, 1993)
• Pazienti cerebrolesi sinistri durante il pranzo appaiono disorganizzati
nell’esecuzione delle azioni (Foundas et al, 1995)
• Paziente che nella vita quotidiana commetteva errori di natura aprassica in
numerose azioni, sottoposto a training riabilitativo (Corato et al, 2002)
• Fattore prognostico sfavorevole per recupero ADL: review (Meijer et al,
2003)
• Gravità IMA correla con Physical Self-Maintenance Scale (Hanna-Pladdy et
al, 2003)
Evidenze a favore del
ruolo disabilitante
dell’aprassia nelle ADL
15. Nome paziente M.V.
Eta’ 73
Sesso M
Scolarita’ 13 anni
Preferenza manuale Destrimane
Distanza dall’ictus 45 giorni
Sede della lesione Temporo-insulare
cortico-sottocorticale sx
Gravita’ neurologica
(European stroke scale)
96
• Token test: 28/77
• Raven test: 15/36
• Aprassia bucco-facciale: 1/20
• Aprassia costruttiva: 13/14
• Aprassia ideo-motoria: 11/72
• Aprassia ideativa: 2/14
RELAZIONE TRAAPRASSIA E DISABILITA’: STUDIO SU UN
PAZIENTE AFFETTO DA LESIONE EMISFERICA SINISTRA
E. Corato, M. Benelle, A. Fiaschi, L. Favretti, S. M. Aglioti, C. Galvani, N. Smania.
•Radersi
•Lavarsi
•Sbucciare frutta
•Uso posate
•Fare caffè
•Aprire yogurt
•Aprire-chiudere cerniera
•Mettere cintura
•Mettere cravatta
•Giocare carte
Società Italiana di Riabilitazione Neurologica
Secondo Congresso Nazionale
Lerici (La Spezia)
10-12 ottobre 2002
16. Elementi a favore della riabilitazione
dell’aprassia
• L’aprassia può essere un disturbo disabilitante
• L’aprassia rende difficoltoso il trattamento
riabilitativo motorio dei pazienti con emiparesi
• L’aprassia riduce il potenziale di comunicazione
gestuale dei pazienti gravemente afasici
17. Approcci riabilitativi all’aprassia
degli arti
1. di specifici errori gestuali
2. generale delle anomalie di produzione di gesti
(transitivi, intransitivi, simbolici e non)
3. di anomalie di esecuzione di attività della vita
quotidiana
Mirati alla correzione:
18. Maher L.M. and Ochipa C. (1997). Management and treatment of limb apraxia.
In LJG Rothi and KL Heilman (Eds.); Apraxia: the neuropsychology of action.
Hove, UK: Lawrence Erlbaum Associates Ltd.
Trattamento di specifici errori gestuali
19. The Rehabilitation of Limb Apraxia: A Study in
Left-Brain Damaged Patients
Nicola Smania MD, Flavia Girardi SP, Chiara Domenicali PT, Elisa Lora PT, Salvatore Aglioti MD
Arch Phys Med Rehabil 2000; 81: 379-88
OBJECTIVE: To assess the effectiveness of a rehabilitative training program for patients with limb apraxia. DESIGN: Randomized,
controlled trial. SETTING: Neurologic rehabilitation unit of a university hospital. PATIENTS: Thirteen patients with acquired brain
injury and limb apraxia (lasting more than 2months) as a result of lesions involving the left cerebral hemisphere. Patients were assigned
to a study group or to a control group following a randomization scheme. The study group underwent an experimental training for limb
apraxia. The control group received conventional treatment for aphasia. INTERVENTION: A behavioral training program consisting of
gesture-production exercises. The rehabilitative program was made up of 3 sections dedicated to the treatment of gestures with or
without symbolic value and related or nonrelated to the use of objects. Thirty-five experimental sessions, each lasting 50 minutes, were
given. MAIN OUTCOME MEASURES: Neuropsychologic tests for assessment of aphasia, verbal comprehension, "general
intelligence," oral apraxia, constructional apraxia, and 3 tests concerning limb praxic function (ideational apraxia, ideomotor apraxia,
gesture recognition). Scores related to each test were used to measure the outcome. Video recordings of ideational and ideomotor apraxia
tests allowed us to register type and number of praxic errors. All outcome measures, except the aphasia test, were recorded before and
after the experimental (or control) treatment time interval. RESULTS: The patients in the study group achieved a significant
improvement of performance in both ideational (p = .039) and ideomotor (p = .043) apraxia tests. They also showed a significant
reduction of errors in ideational (p = .001) and ideomotor (p < .001) apraxia tests. A trend toward improvement was found in the gesture
comprehension test (p = .058), while other outcome measures did not show any significant amelioration. Control patients did not show
any significant change in performance. CONCLUSIONS: The results show the possible effectiveness of a specific training program for
the treatment of limb apraxia.
Trattamento generale delle anomalie gestuali
20. Demographic and Clinical Features of the
Patient Groups
Study group
• Age 69.3
• Sex 5M, 1M
• Education (yrs) 5.8
• Hand Pref. (-24, +24) 23.3
• Neur. Sev. (0-18) 6.5
• Duration of stroke 14.7
Control group
• Age 62.1
• Sex 5M, 2M
• Education (yrs) 6.3
• Hand Pref. (-24, +24)23.7
• Neur. Sev. (0-18) 7.1
• Duration of stroke 12.1
Smania et. Al. Arch Phys Med Rehabil 2000; 81: 379-88
21. Training riabilitativo
I sezione II sezione III sezione
Gesti intransitivi
simbolici
Gesti intransitivi
non-simbolici
Gesti di utilizzazione
I fase II fase III fase I fase II fase III fase
Smania et. Al. Arch Phys Med Rehabil 2000; 81: 379-88
22. I Fase
II Fase III Fase
Training:
“gesti transitivi”
Contesto 1 Gesto
Foto gesto Pantomima gesto Pantomima gesto
Foto oggetto
23. I Fase
II Fase III Fase
Training:
“gesti simbolici”
Contesto 1
Gesto
Contesto 1 Contesto 2
25. 0
2
4
6
8
10
12
14
16
18
20
Number
of
gestures
No cues Verbal cues Any cue
Transitive Intransitive symbolic
A B C A B C
Phase
changing
level
Meaningless
17
PERFORMANCE DI UN PAZIENTE APRASSICO
DURANTE IL TRATTAMENTO RIABILITATIVO
Smania et. Al. Arch Phys Med Rehabil 2000; 81: 379-88
27. REHABILITATION OF LIMB APRAXIA IN PATIENTS WITH
BRAIN DAMAGE
N. Smania , S. M. Aglioti, E. Corato, F. Girardi, S. Schena, A. Fiaschi
Objectives: To assess the effectiveness of a rehabilitative training program for patients with limb apraxia.
Methods: Twenty-six patients with acquired brain injury and limb apraxia (lasting more than 2 months) as a result of lesions involving the left cerebral
hemisphere participated in the study. Patients were assigned to a study group or to a control group following a simple randomization procedure. The
study group underwent an experimental rehabilitative training for limb apraxia. The control group received conventional treatment for aphasia. The
experimental program consisted of gesture–production exercises. There were three sections dedicated to the treatment of gestures with or without
symbolic value and related or non-related to the use of objects. Thirty-five experimental sessions, each lasting 50 minutes, were given. Main outcome
measures consisted of neuropsychologic tests for assessment of aphasia, verbal comprehension, “general intelligence”, oral apraxia, constructional
apraxia, activities of daily living, and three tests concerning limb praxic function (ideational apraxia, ideomotor apraxia, gesture recognition). Scores
related to each test were used to measure the outcome. Video recordings of ideational and ideomotor apraxia test allowed us to register type and number
of praxic errors. All outcome measures, except the aphasia test, were recorded before and after the experimental (or control) treatment time interval.
Results: The patients in the study group achieved a significant improvement of performance in both ideational ( p = .045) and ideomotor (p = .022)
apraxia test. They also showed a significant reduction of errors in ideational ( p = .005) and ideomotor (p = .003) apraxia test. A significant improvement
was also found in the gesture comprehension test (p = .010) and in the activities of daily living test (p = .005). The patients in the control group showed a
significant improvement in performance only in the Raven (p = .036) and Token (p = .027) test.
Conclusions: The results show the effectiveness of a specific training program for the treatment of limb apraxia.
3rd Word Congress in
Neurological Rehabilitation
Venice, 2-6 april 2002
28. ADL TEST
• IGIENE PERSONALE (7 items)
• ALIMENTAZIONE (4 items)
• ABBIGLIAMENTO (9 items)
O – Assenza di funzione
1 – Funzione con assistenza
2 – Funzione autonoma con supervisione
3 – Funzione autonoma con difficoltà
4 – Funzione autonoma completa
29. 0
10
20
30
40
50
60
70
80
90
100
Sper Cont Sper Cont Sper Cont Sper Cont SperCont Sper Cont
Valori
percentuali
PRIMA
DOPO
BEFORE
AFTER
BEFORE
AFTER
BEFORE
AFTER
BEFORE
AFTER
BEFORE
AFTER
AIM
COMPR GESTO
APR ORALE
ADL
*
*
* *
AI
APR COSTR
%
TEST AI; AIM; COMPRENSIONE DEL GESTO;
APRASSIA ORALE; APRASSIA COSTRUTTIVA; ADL
Risultati
30. Trattamento di specifiche attività della vita quotidiana
Therapy of Activities of Daily Living in Patients with Apraxia
G. Goldenberg and S. Hagmann
Neuropsychological Rehabil 1998; 8 (2), 123-41
31. Obiettivi: Valutare il grado di disabilità generato dalla presenza di aprassia e l’efficacia di un trattamento riabilitativo mirato al
miglioramento dell’abilità di pianificazione ed esecuzione di azioni nel contesto delle attività quotidiane (AQ).
Metodi: Un paziente, MV, destrimane, affetto da afasia globale e da aprassia degli arti, in seguito ad una lesione ischemica in regione
temporo-insulare cortico-sottocorticale sx (età 73 anni), è stato oggetto del nostro studio. A distanza di 45 giorni dall’evento ictale è stato
preso in carico presso il servizio di Logopedia del Policlinico GB Rossi di Verona. Il paziente, alla valutazione neuropsicologica iniziale,
mostrava le seguenti prestazioni: Token test, 28/77; Raven, 15/36; aprassia bucco-facciale, 1/20; aprassia costruttiva, 13/14; aprassia ideo-
motoria, 11/72 e aprassia ideativi, 2/14. Un’intervista alla moglie del paziente evidenziava che MV presentava notevoli difficoltà nello
svolgimento delle AQ palesemente legate al disturbo prassico. Nell’ambito delle AQ sono state selezionate 10 attività la cui esecuzione
risultava particolarmente difficoltosa per MV. La moglie del paziente è stata sottoposta ad un questionario in cui per ognuna delle suddette
attività doveva essere indicato il grado di difficoltà incontrato da MV secondo una scala visuo-analogica (VAS). Una “baseline” della
performance del paziente è stata ottenuta ripetendo il suddetto test per 4 volte in 4 giorni consecutivi. Successivamente la moglie del
paziente è stata addestrata a seguire MV nello svolgimento di ognuna delle suddette attività, aiutandolo tramite facilitazioni verbali, o
correggendolo passivamente, manualmente, nel corso delle azioni eseguite in maniera deficitaria. Quotidianamente venivano dedicati 10
minuti di training per ognuna delle attività. In totale sono stati effettuati 20 giorni di training. Alla conclusione del periodo di trattamento
domiciliare la moglie è stata sottoposta nuovamente al questionario di valutazione della disabilità.
Risultati: La baseline pre-trattamento era stabile. Al termine del trattamento il paziente ha mostrato un miglioramento delle prestazioni in
tutte le attività sottoposte a training. La moglie riferiva che il miglioramento non si estendeva ad altre attività della vita quotidiana.
Conclusioni: I risultati mostrano una relazione tra disturbo aprassico e disabilità e la possibile efficacia di un trattamento mirato alla
riabilitazione dell’abilità di pianificazione ed esecuzione delle attività maggiormente rilevanti per la vita di relazione e l’autonomia
personale del paziente.
Società Italiana di Riabilitazione Neurologica
Secondo Congresso Nazionale
Lerici (La Spezia)
10-12 ottobre 2002
RELAZIONE TRAAPRASSIA E DISABILITA’: STUDIO SU UN
PAZIENTE AFFETTO DA LESIONE EMISFERICA SINISTRA
E. Corato, M. Benelle, A. Fiaschi, L. Favretti, S. M. Aglioti, C. Galvani, N. Smania.
33. Conclusioni
Il trattamento riabilitativo dell’aprassia dovrebbe essere incluso tra le
comuni procedure di riabilitazione neuropsicologica
Possono essere utili:
1) trattamenti mirati a correggere in maniera estensiva gli errori prassici
2) trattamenti mirati a rendere il paziente autonomo in specifiche ADL
Ulteriori sviluppi della ricerca:
•Valutare mantenimento a distanza delle abilità acquisite
•Valutare se la riabilitazione dell’aprassia migliora le
abilità comunicative del paziente afasico
•Valutare se la riabilitazione dell’ aprassia migliora
l’outcome del paziente con ictus cerebrale