IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy.
J Telemed Telecare. 2023 Jul;29(6):451-460. doi: 10.1177/1357633X21990195. Epub 2021 Feb 3.
Severe acquired brain injury(SABI) often results in the deterioration of physical, cognitive and emotional functions in the patient and a significant caregiver's distress syndrome, which is now amplified by the social isolation, depression and financial difficulties related to the COVID-19 pandemic. The use of web-based online-therapy has been shown to be useful to overcome caregiver's distress syndrome and further stimulate cognitive-motor recovery of SABI-patients. Our study aimed to investigate whether a systematic online Skype-therapy(OLST) may be of support in favoring global cognitive and sensory-motor recovery in SABI-patients and reducing caregiver distress.
Twenty-five SABI-subjects in inpatient regimen were provided with intensive OLST with the caregiver for 12 weeks in addition to standard neurorehabilitation. Each subject and caregiver was evaluated before and after the treatment by administering an ad hoc battery. Furthermore, 18 of 27 patients were provided with EEG recording in resting state.
We found a significant reduction in caregiver's anxiety (p<0.0001) and burden(p<0.0001). Patients showed significant improvement in trunk control (p<0.0001), functional independence (p = 0.005), functional (p = 0.01) and global communication (p = 0.004), cognitive functioning (p = 0.001), and behavioral responsiveness (p = 0.0004). The training yielded a significant connectivity change within the fronto-centro-parietal areas in the delta frequency band (p<0.0001) and the centro-parieto-occipital areas in the alpha range (p = 0.004).
OLST may be a useful and complementary treatment to optimize global cognitive and functional recovery in SABI-subjects and reduce caregivers' concerns in the Covid-era. OLST can foster cognitive-motor recovery potentially by favoring the plasticity-dependent functional recovery. Therefore, OLST could be proposed as a tool allowing social conversations also in the hospital setting.
严重获得性脑损伤（SABI）常导致患者身体、认知和情感功能恶化，以及照顾者严重的痛苦综合征，而 COVID-19 大流行带来的社会隔离、抑郁和经济困难进一步加剧了这种情况。已证明，基于网络的在线治疗有助于克服照顾者的痛苦综合征，并进一步刺激 SABI 患者的认知运动康复。我们的研究旨在调查系统的 Skype 在线治疗（OLST）是否有助于促进 SABI 患者的整体认知和感觉运动康复，并减轻照顾者的痛苦。
25 名住院的 SABI 患者在接受标准神经康复治疗的基础上，与照顾者一起接受 12 周的强化 OLST。每位患者和照顾者在治疗前后都接受了专门的电池评估。此外，27 名患者中的 18 名接受了静息状态下的 EEG 记录。
我们发现照顾者的焦虑（p<0.0001）和负担（p<0.0001）显著降低。患者的躯干控制（p<0.0001）、功能独立性（p=0.005）、功能（p=0.01）和整体交流（p=0.004）、认知功能（p=0.001）和行为反应性（p=0.0004）显著改善。训练在 delta 频带（p<0.0001）的额-中-顶区和 alpha 频带（p=0.004）的中-顶-枕区产生了显著的连接变化。
OLST 可能是一种有用的补充治疗方法，可以优化 SABI 患者的整体认知和功能恢复，并减轻 COVID 时代照顾者的担忧。OLST 可以通过促进依赖可塑性的功能恢复来促进认知运动康复。因此，OLST 可以作为一种工具，允许在医院环境中进行社交对话。
