Una revisión de escalas de evaluación para medir el cambio de conducta debido a la lesión cerebral y el tratamiento de estos cambios

Introduction: People who have suffered a brain injury often experience a wide range of cognitive, emotional and behavioural disorders. Neuropsychological rehabilitation used to focus on the cognitive aspects, giving little or no attention to the other changes. In this context the behavioural changes are a big handicap for their rehabilitation and adaptation to society. Aim: To review the findings obtained in studies on scales assessing behavioural changes in acquired brain injury (ABI) and to apply specific treatments. Method: The review included original articles and treatments, which used questionnaires to assess and improve the behavioural changes in adults who had suffered an ABI. CINAHL and MEDLINE databases between the years 1990-2014 were consulted. Instruments used in adults with DCA were selected. Psychiatric scales applied to people without brain damage were excluded. Results: The search yielded a large number of references and several instruments were identified. Most quantified behavioural changes, but also many emotional, psychiatric or quality of life issues are addressed. Most self-administered scales assess both the patient and the family or caregiver. Conclusions: Despite the limited range of scales involved in the assessment of behaviour, suitable tools were found in clinical practice for the diagnosis of behavioral changes. Regarding treatment, the literature describes studies of single and group cases, however, no single treatment for patients with DCA is identified.ResumenIntroducción: Las personas que han sufrido una lesión cerebral suelen experimentar un amplio conjunto de alteraciones cognitivas, emocionales y conductuales. La rehabilitación neuropsicológica acostumbra a centrarse en los aspectos cognitivos, dando escasa o nula atención al resto de cambios. En este contexto los cambios conductuales son un gran hándicap para la rehabilitación y la adaptación a la sociedad. Objetivo: Revisar los hallazgos obtenidos en estudios sobre escalas que evalúan los cambios de conducta en lesión cerebral y apliquen tratamientos específicos. Método: La revisión incluyó artículos originales que utilizaban algún cuestionario y tratamiento para valorar y mejorar los cambios conductuales en adultos que habían sufrido una lesión cerebral. Se consultaron las bases de datos CINAHL y MEDLINE entre los años 1990 a 2014. Se seleccionaron instrumentos utilizados en población adulta con lesión cerebral. Se excluyeron escalas psiquiátricas o aplicadas a población sin daño cerebral. Resultados: La búsqueda produjo un gran número de referencias y se identificaron varios instrumentos. La mayoría cuantificaban los cambios conductuales, pero además en muchos de ellos se abordan aspectos emocionales, psiquiátricos o de calidad de vida. La mayoría de las escalas se auto-administraban tanto al paciente como al familiar o cuidador. Conclusiones: A pesar de la poca variedad de escalas dedicadas a la evaluación de la conducta, se encontraron instrumentos idóneos en la práctica clínica para el diagnóstico de cambios conductuales. Respecto al tratamiento, la literatura describe estudios de caso único y grupal; sin embargo, no se considera que exista un tratamiento único para los pacientes con lesión cerebral. AbstractIntroduction: People who have suffered a brain injury often experience a wide range of cognitive, emotional and behavioural disorders. Neuropsychological rehabilitation used to focus on the cognitive aspects, giving little or no attention to the other changes. In this context the behavioural changes are a big handicap for their rehabilitation and adaptation to society. Aim: To review the findings obtained in studies on scales assessing behavioural changes in acquired brain injury (ABI) and to apply specific treatments. Method: The review included original articles and treatments, which used questionnaires to assess and improve the behavioural changes in adults who had suffered an ABI. CINAHL and MEDLINE databases between the years 1990-2014 were consulted. Instruments used in adults with DCA were selected. Psychiatric scales applied to people without brain damage were excluded. Results: The search yielded a large number of references and several instruments were identified. Most quantified behavioural changes, but also many emotional, psychiatric or quality of life issues are addressed. Most self-administered scales assess both the patient and the family or caregiver. Conclusions: Despite the limited range of scales involved in the assessment of behaviour, suitable tools were found in clinical practice for the diagnosis of behavioral changes. Regarding treatment, the literature describes studies of single and group cases, however, no single treatment for patients with DCA is identified.