RESUMEN
INTRODUCTION: Memory impairments affecting encoding, acquisition, and retrieval of information after moderate-to-severe traumatic brain injury (TBI) have debilitating and enduring functional consequences. The interventional research reviewed primarily focused on mild to severe memory impairments in episodic and prospective memory. As memory is a common focus of cognitive rehabilitation, clinicians should understand and use the latest evidence. Therefore, the INCOG ("International Cognitive") 2014 clinical practice guidelines were updated. METHODS: An expert panel of clinicians/researchers reviewed evidence published since 2014 and developed updated recommendations for intervention for memory impairments post-TBI, a decision-making algorithm, and an audit tool for review of clinical practice. RESULTS: The interventional research approaches for episodic and prospective memory from 2014 are synthesized into 8 recommendations (6 updated and 2 new). Six recommendations are based on level A evidence and 2 on level B. In summary, they include the efficacy of choosing individual or multiple internal compensatory strategies, which can be delivered in a structured or individualized program. Of the external compensatory strategies, which should be the primary strategy for severe memory impairment, electronic reminder systems such as smartphone technology are preferred, with technological advances increasing their viability over traditional systems. Furthermore, microprompting personal digital assistant technology is recommended to cue completion of complex tasks. Memory strategies should be taught using instruction that considers the individual's functional and contextual needs while constraining errors. Memory rehabilitation programs can be delivered in an individualized or mixed format using group instruction. Computer cognitive training should be conducted with therapist guidance. Limited evidence exists to suggest that acetylcholinesterase inhibitors improve memory, so trials should include measures to assess impact. The use of transcranial direct current stimulation (tDCS) is not recommended for memory rehabilitation. CONCLUSION: These recommendations for memory rehabilitation post-TBI reflect the current evidence and highlight the limitations of group instruction with heterogeneous populations of TBI. Further research is needed on the role of medications and tDCS to enhance memory.
Asunto(s)
Lesiones Traumáticas del Encéfalo , Lesiones Encefálicas , Encefalopatía Traumática Crónica , Estimulación Transcraneal de Corriente Directa , Humanos , Lesiones Encefálicas/rehabilitación , Acetilcolinesterasa , Entrenamiento Cognitivo , Lesiones Traumáticas del Encéfalo/psicología , Trastornos de la Memoria/etiología , Trastornos de la Memoria/rehabilitaciónRESUMEN
OBJECTIVE: Twenty-five years ago, the field of neuropsychology was well established in North America, Europe, and Australia, with less presence elsewhere. This article discusses the development of neuropsychology over the last 25 years in other regions. METHOD: The growth of neuropsychology in Asia, Africa, the Middle East, Central and South America, and New Zealand is reviewed. Sources drawn on include a 2016 edition of The Clinical Neuropsychologist describing the practice of neuropsychology in 18 countries; papers on the profession of neuropsychology in Latin America (Arango-Lasprilla, Stevens, Paredes, Ardila, & Rivera, 2016), the history of neuropsychology in Asia (Lee, Wang, & Collinson, 2016), and neuropsychology in Central America (Judd, 2017); INSNET; and personal communications. CONCLUSIONS: There has been tremendous variability in the development of neuropsychology across these regions over the last 25 years. Obstacles to the growth of neuropsychology have included economic constraints on health care provision, limited availability of appropriate assessment and treatment methods, linguistic diversity and illiteracy, stigma toward and/or lack of awareness of neuropsychological disorders, lack of graduate training and clinical supervision, absence of accreditation of neuropsychologists as a clinical profession, poor pay, and diminished visibility of the field within the regional culture. Despite these obstacles, neuropsychological research and practice is establishing itself in these regions and has grown significantly over the last quarter century. Major challenges remain in establishing awareness of the significance of and developing culturally appropriate methods of assessing and rehabilitating cognitive aspects of brain disorders, training programs, recognition as a profession, and dedicated funding for neuropsychology positions. (PsycINFO Database Record