Co-location analysis of pedestrian accident attributes for Ankara.

Even though accidents with pedestrians are more likely to have a severe or fatal outcome, most research concentrates on the vehicle part of the accidents. To make better policies and infrastructure decisions it is crucial to understand how and why such accidents happen. In this article, 2.588 pedestrian accidents from the year 2018 that resulted in injury or death in the city of Ankara, Türkiye are considered, and different attributes are analyzed co-location-wise. Three types of analysis will be undertaken for these accidents: temporal, natural environment, and pedestrian characteristics. The season of the year, weekend-weekday, and time of day will be explored for the temporal analysis. Visibility (daylight, twilight, and darkness) and rain are the natural surroundings of interest. The analyzed pedestrian characteristics are age group, gender, clothing colour, and nationality. Generally, the accident properties are evenly distributed and mostly the higher co-locations occur with themselves. Three important results stand out in this study. Firstly, the type of precaution appropriate to different time periods of the day should be applied, taking into account the locations that have the strongest co-location with themselves. Secondly, a seasonal approach should be adopted in determining places where pedestrian safety needs to be increased in the city. Lastly, pedestrian safety measures targeting especially both '0-14 and 65 + age groups' and 'foreign citizenship' should be prioritized in the identified locations. The results show that the co-location methodology is a good fit for analyzing pedestrian accidents and a wider use of this methodology for other accident types and in general might be beneficial.

A systematic literature review on occupational accident factors in the rail construction industry: lessons learned from a quarter-century of studies globally.

The rail construction industry is notable for its large scale, substantial investment, extensive stakeholders involvement, long construction period, and intricate operation and technology. This industry is among the most dangerous due to the highest number of occupational accident cases worldwide. Therefore, it is crucial to analyse and identify the existing literature on occupational accident factors in rail construction. To address the research aim, the study identified the factors that contribute to occupational accidents using systematic review methodology. This systematic literature review adheres to the rigorous Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Relevant publications from the past 25 years were retrieved from Scopus, Web of Science (WoS), and Science Direct electronic databases. Through a meticulous review of 43 selected publications, five accident factor themes were discovered: worker, workplace, materials and equipment, organizational, and environmental influences. The detailed analysis of these themes has led to the identification of 19 specific sub-factors within these categories, providing a granular understanding of the intricate elements contributing to accidents. This study offers a foundational understanding of accident factors in the rail construction industry, paving the way for targeted OSH interventions aimed at preventing occupational accidents in the future.

Golden Jackal (Canis aureus) death by road accident in rural Bengal-insight the fact: a perception based eco-spatial clarification.

Golden jackal is one of the higher trophic level wild animals in rural Bengal. Their ecological significance is undeniable in regional ecosystems and biodiversity. But gradually they become threatened due to habitat contraction, road killing, poisoning and human persecution. The documentation of jackal death by road accident within the 12-km district highway which is a single lane bituminous road in Patshpur-I Community Development Block under Purba Medinipur district, India, reveals an unpredictable ecological circumstance (n-154). Jackals are killed by road accidents from 2022 to 2023. On behalf of this blameless situation, the present study conducted intensive observations, case studies and spatial-ecological analysis. The study also included stakeholder's perceptions to reach and relates the background of this fact. After observation and analysis, it has been found that the jackal deaths have a spatio-temporal signature and are connected with food and forage ground loss from their habitat-influenced area. Another outcome is that roadside habitat becomes an alternative food source and forage ground for them due to trench construction both alongside of the district highway and illegal dumping of meat wastes and domestic wastes. The seasonal biological activities of the jackals, local weather phenomena and car driver negligence are responsible for the accidental death of jackals along the district highway. Considering all the observed factors, the present study shared some reliable measures to control, protect and conserve this animal for balancing regional ecosystem as well as biodiversity in rural Bengal.

Silent severe aortic regurgitation due to blunt chest trauma: ignore it at your peril-a case report.

Background: Blunt chest trauma (BCT) presenting to the emergency department is common and may cause life-threatening cardiac complications. Whilst complications causing haemodynamic instability are generally detected promptly, others may present late with long-term consequences. We describe a rare, serious complication of BCT presenting five years after a road traffic accident (RTA). Case summary: A 23-year-old man was incidentally found to have a murmur. Past history was notable only for BCT with rib fracture sustained in a RTA 5 years prior. Examination revealed a hyperdynamic pulse, loud decrescendo diastolic murmur, and Duroziez's sign over the femoral arteries. Echocardiography showed severe valvular aortic regurgitation (AR) from a hole in the left coronary cusp and holodiastolic flow reversal in the descending aorta. The left ventricle (LV) showed marked dilatation in diastole, mild dilatation in systole, and preserved systolic function. The aorta was normal. Severe AR was attributed to his previous BCT, with AR causing subsequent LV dilatation. He underwent aortic valve replacement (AVR) with rapid recovery. He remains well, and his echo shows a well-functioning AVR with normalization of LV dimensions. Discussion: Aortic regurgitation following BCT is rare but well-recognized, most often resulting from RTAs. Only a third of cases are diagnosed acutely. In others, lack of haemodynamic instability means that emergency echocardiography is not routinely performed, such that this may go unrecognized with long-term consequences. Clinicians should be aware of possible valve damage following BCT. Prompt echocardiography should be routinely performed for all BCT at initial presentation, even without haemodynamic instability.

Characteristics of exposure to radioactive iodine during a nuclear incident.

BACKGROUND: During a nuclear accident, numerous products of nuclear fission are released, including isotopes of radioactive iodine. Among them is iodine-131, with a half-life of 8.02 days, which emits ß radiation. For decades, it has been effectively and safely used in medicine. However, in the event of a nuclear accident, uncontrolled exposure can have harmful biological effects. The main sources of internal contamination with iodine-131 are contaminated air, food and water. The most exposed organ is the thyroid gland, where radioactive iodine accumulates via the Na+/I- symporter (NIS). NIS does not distinguish between radioactive iodine isotopes and the stable isotope iodine-127, which is essential for the synthesis of thyroid hormones. Exposure to radioactive iodine during a nuclear accident is primarily associated with papillary thyroid cancer, whose incidence begins to increase a few years after exposure. Children and adolescents are at the highest risk, and the risk is particularly significant for individuals living in iodine-deficient areas. CONCLUSIONS: Ensuring an adequate iodine supply is therefore crucial for lowering the risk of the harmful effects of exposure to radioactive iodine at the population level. Protecting the thyroid with potassium iodide tablets significantly reduces radiation exposure, as stable iodine prevents the entry of radioactive iodine into the thyroid. Such protection is effective only within a narrow time window - a few hours before and after the exposure and is recommended only for those under 40 years of age, as the risks of excessive iodine intake outweigh the potential benefits in older individuals.

Test-Retest Reliability, Clinical Usefulness, and Telephone Application of the Work Limitation Questionnaire in Individuals Who Returned to Work After Stroke.

PURPOSES: To measure the test-retest reliability and the clinical usefulness of the Work Limitation Questionnaire, and to compare the in-person with the telephone application. METHODS: Cross-sectional, exploratory study. The Work Limitation Questionnaire was answered three times: twice in person, to measure test-retest reliability and clinical usefulness, and once, by telephone, to measure the validity of the telephone application. RESULTS: Fifty-six individuals (32 men) with mild to moderate disabilities after stroke were included. Test-retest reliability was very high (ICC 0.96; 95% CI 0.94 to 0.98; p < 0.01), the clinical usefulness was high (9 out of 12 points), and the correlation between in-person and telephone applications was high (ρ = 0.7; 95% CI 0.5 to 0.9; p < 0.01). The average productivity loss was 4% (SD 5, min-max 0 to 15%). CONCLUSIONS: The Work Limitation Questionnaire showed adequate test-retest reliability and clinical usefulness in individuals with stroke. The telephone application produced comparable results to in-person applications. The participants reported low productivity loss, which may be related to the mild impairments of the included sample.

Pre-disaster family visits and post-evacuation return to Fukushima among psychiatric inpatients evacuated to out-of-area hospitals after the nuclear accident.

OBJECTIVE: This study aimed to elucidate the effects of pre-evacuation family hospital visits on post-evacuation returns to Fukushima Prefecture (hometown) among psychiatric inpatients who mandatorily evacuated to hospitals outside the prefecture because of the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. METHOD: Of the inpatients in Fukushima, 44 were admitted to a hospital in the nearby Soso district on March 11, 2011, and were therefore included in the current analysis. We collected information on their discharge after the evacuation and family visits before the evacuation by reviewing the medical records of both the evacuation destination and former hospitals. RESULTS: The average durations from the accident to post-evacuation return among patients with and those without former family visits were 681.8 days (standard error [SE] = 163.3) and 1,027.8 days (SE = 152.0), respectively. The log-rank test showed a tendency of earlier return to Fukushima among inpatients who had received family visits to the hospital before evacuation (p = .073). CONCLUSIONS: The results highlight the critical need for close collaboration between psychiatric medical practitioners and families, to not only support patients' community reintegration into daily life but also facilitate a timely return to their hometowns following long-distance evacuation caused by an unforeseen large-scale disaster.

Factors associated with failure of intraosseous access in prehospital trauma treatment by military medical personnel.

INTRODUCTION: Intraosseous devices have become an alternative to peripheral intravenous (PIV) access. Despite the established success of intraosseous devices in laboratory and simulator studies, there is a lack of data regarding their real-world utilisation in prehospital settings. Therefore, this study aims to evaluate the success rates of intraosseous access in a prehospital military context and identify factors associated with failure. METHODS: Using the Israel Defense Forces (IDF) Trauma Registry, we retrospectively collected data from 2010 to 2023. The primary outcome was the first pass success rate of intraosseous access, and logistic regression models were applied to identify variables associated with first pass failure. RESULTS: The study included 172 trauma patients who underwent attempted intraosseous access with 46.5% cases which were classified as military events. The median age was 22 years, and 17.3% were paediatric patients. First pass success was achieved in 67.4% of cases, with a cumulative success rate of 80.8% after multiple attempts. Moreover, significant differences were noted when examining the success rate of the three intraosseous devices used by the IDF teams, with the highest success rate being documented for the NIO Adult versus the EZ-IO or the BIG (81.4%; 76.7%; 62.4%). However, logistic regression analysis revealed that the number of PIV access attempts was the only variable significantly associated with decreased odds of achieving first pass intraosseous access. CONCLUSION: These findings suggest that intraosseous devices are a viable alternative for establishing vascular access in prehospital military settings. However, success rates were slightly lower than previous reports, potentially due to the severity of injuries in the study cohort. Our analyses revealed a higher number of PIV access attempts correlated with reduced first pass intraosseous success, possibly stemming from caregiver proficiency in obtaining vascular access. Further research is needed to explore additional factors affecting intraosseous access success rates.

Effects of a sedentary behaviour intervention in emergency dispatch centre phone operators: a study protocol for the SECODIS randomised controlled cross-over trial.

INTRODUCTION: Sedentary behaviour is a public health problem. We mainly have sedentary behaviour at work, transforming them into occupational risk. To our knowledge, there is no intervention study on the reduction of occupational sedentary behaviour in a real work situation and its impact on health and biomarkers of stress. The main objective is to study changes in sedentary behaviour following a behavioural intervention (sit-and-stand desk and cycle ergometer). METHODS AND ANALYSIS: This is a randomised controlled trial in cross-over design conducted in a single centre. The study will be proposed to emergency medical dispatchers of Clermont-Ferrand. Each volunteer will be followed during three cycles of 1 week (3 weeks in total). Each 1-week cycle is made up of 12 hours of work (three conditions: a control and two interventions), 12 hours of successive rest and 6 days of follow-up. For each condition, the measurements will be identical: questionnaire, measure of heart rate variability, electrodermal activity and level of physical activity, saliva and blood sampling. The primary outcome is sedentary behaviour at work (ie, number of minutes per day standing/active). Data will be analysed with both intention-to-treat and per protocol analysis. A p<0.05 will be considered as indicating statistical significance. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics Committee Ouest IV, FRANCE. The study is registered in ClinicalTrials.gov. All patients will be informed about the details of the study and sign written informed consent before enrolment in the study. Results from this study will be published in a peer-reviewed journal. This study involves human participants and was approved by Comité de protection des personnes Ouest IVCPP reference: 23/132-2National number: 2022-A02730-43. TRIAL REGISTRATION NUMBER: NCT05931406.

Comprehensive Analysis of Risk Factors and Prognostic Outcomes in Cases of Cerebral Venous and Sinus Thrombosis in a Tertiary Care Setting.

Background Cerebral venous and sinus thrombosis (CVT) is one of the most common causes of stroke in young people. With timely diagnosis and the right medical attention, this relatively rare neurologic condition may be curable. Finding the risk variables and outcome determinants is the aim of this study. Methodology A two-year prospective observational research was carried out in a tertiary care facility. Notable were the patient's demographics, symptomatology, and risk factor history. The Modified Rankin Scale (mRS) was employed to assess the patient's outcome and prognosis both at admission and after six weeks. The mRS scores at admission and follow-up were compared concerning outcome factors using the chi-square test. Results In all, there were 75 people with CVT. More men (42 patients, 56%) than women (33 patients, 44%), particularly in their third decade, were impacted. Polycythemia (22 patients, 29.3%) was the most prevalent risk factor, followed by the use of oral contraceptives (14 patients, 18.7%). Based on their mRS scores upon entry, 38 individuals (50.7%) were classified as functionally independent (mRS < 2), whereas 37 individuals (49.3%) were deemed functionally dependent (mRS > 2). At the six-week follow-up, 54 patients (72%) were functionally independent. Decompressive craniotomies were performed on 15 patients (20%), of which 10 (13.33%) had improvement, two (2.67%) had deterioration, and one patient passed away. The percentage of deaths was 1.33%. Two patients (2.67%) were not followed up with. Conclusion The present findings highlight that CVT predominantly affects younger individuals with a slight male predominance. The leading risk factors were polycythemia and the use of oral contraceptive pills (OCPs). Despite generally favorable prognoses with appropriate management, poorer outcomes were linked to altered consciousness, neurological deficits, and intracerebral hemorrhage (ICH) at presentation.

Periocular Involvement in Trigeminal Trophic Syndrome.

Trigeminal trophic syndrome (TTS) is an uncommon condition resulting from trigeminal nerve damage, characterized by persistent facial ulceration, loss of sensation, and paresthesia within the trigeminal dermatome, with ala nasi involvement being a key feature. Lesions develop from repeated self-inflicted manipulation and trauma of the dysesthetic skin. This report details three cases of TTS, highlighting periocular changes, with etiologies varying from cerebrovascular accidents to herpes zoster ophthalmicus.

Road traffic injury among elderly people and its determinant factors: a cross-sectional study.

Background and aims: Injuries from Road Traffic Accidents (RTAs), particularly among vulnerable groups such as the elderly, are considered a significant public health concern. The aim of this study was to show epidemiology of RTIs among the elderly people in the Eastern Azerbaijan province of Iran. Method: This cross-sectional study included all patients over 60 years old who admitted to the Shohada Hospital from 2006 to 2016. Data were extracted from the Hospital Information System. Injuries types were classified based on the International Classification of Diseases (ICD-10). Descriptive statistics (Mean, median and frequency) and inferential statistics (The Pearson Chi-square test) were used for data analysis through SPSS-24 software. Results: A total of 3509 RTAs involving patients over 60 years old from 2006 to 2016. These traffic-related injuries comprised 15% of all recorded injuries (23,321 cases). The mean age of the patients was 69.91 ± 7.61 years, with a predominant male representation (2324 patients, 64.74%). The median Length of Stay (LOS) in hospital was 3 days. Injuries most commonly affected the knee and lower leg regions (27.5%). The most frequent types of accidents were those involving car passengers (40.47%) and pedestrians (36.33%). The majority of RTAs occurred during the summer season. There was a significant difference in the rate of RTAs based on variables such as sex, age, season, and LOS (p < 0.001). Conclusion: The study highlights traffic-related injuries among the elderly, mostly affecting the knee and lower leg regions, especially during the summer season. The efforts should include enhancing safety measures for car passengers and pedestrians, particularly during the high-risk summer months. Also, it emphasizes the need for public transportation to improve safety for older people due to lower accident rates and senior-friendly features.

Safety barriers under changing operating conditions-An analysis of impact parameters in Germany.

Vehicle restraint systems and especially the impact of a collision on such are subject to various influencing variables. These systems are tested and approved through vehicle impact tests to ensure that safety standards are met as well as to ensure comparability amongst the systems. However, differences in the objectives of the standard DIN EN 1317 and the behaviour in practice have become apparent. There is the standard DIN EN 1317 which defines the impact tests on testing grounds. Nevertheless, there are a number of influencing parameters such as developments in the vehicle fleet over the last years, available safety barriers, including their construction types and the impact itself. Previous research indicates that there could be a gap between these parameters. This research uses an empirical analysis based on chiefly quantitative data sources to evaluate the differences between these parameters. It leads to a partial divergence between static requirements of the standard and the actual road traffic conditions. Additionaly, the differences are developed within a vulnerability analysis and for the purpose of comparison, the advantages as well as the disadvantages of the standardized impact tests are discussed in this paper. As a result, a parameter based suggestion for a reevaluation of impact tests for safety barriers, according to the standard DIN EN 1317, is advisable due to the changing road traffic on the current stock and new barrier systems to be built. This research strives to illuminate the trend for new investigation methods such as the finite element method (FEM) simulation. It gives an outlook to further research needs in safety barriers, principally in the observation of the future development of the impact parameters. At the same time, impulses and potential for improvement can be identified for the future documentation of vehicle impacts on these barriers.

The Great Role of Ventilator Parameters in Diagnosis of Right Main Bronchus Rupture Due to Blunt Chest Trauma.

Bronchial rupture following major blunt chest trauma should be suspected in any case of massive and persistent air leak through the intercostal drain tube. Chest radiographs and chest computed tomography scans (CT scans) are highly suggestive of this extremely rare tracheobronchial injury. The present study reported a patient who was a 15-year-old boy. He was a case of a motor-car accident and was brought to the emergency room (ER) of Rajaie Hospital ( Shiraz, Iran) due to dyspnea and chest pain. The physical examination revealed a few crash injuries on his upper extremities, as well as subcutaneous emphysema in his neck. The chest X-ray revealed a right clavicular fracture, multiple rib fractures, a right pneumothorax (but no complete collapse or fallen lung), and also pneumo-mediastinum and subcutaneous emphysema. The chest CT revealed severe pulmonary contusion, severe right-sided pneumothorax, significant pneumo-mediastinum, subcutaneous emphysema, multiple right-side rib fractures, and mild displacement of the right main bronchus. Furthermore, no definitive signs of bronchial rupture were detected. Using a mechanical ventilator, the following parameters were revealed. The maximum pressure (Pmax)=7cm, H2o (was very low), plateau pressure (P. Plateau), and expiratory tidal volume (TV) were not detected due to insufficient amounts. Additionally, increasing TV did not change those values. Bronchial rupture is one of the most important and serious differential diagnoses in forceful chest traumas when the mechanical ventilator reveals low Pmax, very low P.platue, and expiratory TV, with no change in those values with increasing TV.

Assessing the frontline competency gap: Emergency care perceptions among nurses in Yemen's conflict zone.

BACKGROUND: Nursing competencies in armed conflict situations are critical for effective response and recovery. This study explores nurses' perceptions regarding their competencies in armed conflict zones to identify areas of proficiency and those requiring further emphasis in training. METHODS: This cross-sectional descriptive study adhered to the STROBE reporting guidelines. It used a validated questionnaire examining 47 different competencies for nursing in armed conflict zones, which were subsequently ranked to identify those that were valued most and least. RESULTS: In total, 102 questionnaires were returned (85% response rate). The highest-ranked competencies focused on immediate life-saving interventions and personal safety. In contrast, competencies involving broader disaster management, such as understanding organizational disaster plans, post-death care, and risk identification, ranked lower. This observation may indicate a tendency to prioritize direct clinical care over strategic planning and long-term recovery in disaster nursing education. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study highlights the critical need to strengthen emergency care competencies among nurses working in armed conflict zones in Yemen. Its findings underscore the importance of targeted training programs, particularly in complex trauma management and psychological first aid, to address nurses' self-identified competency gaps. Policy implications include prioritizing resource allocation for emergency care infrastructure, implementing competency-based deployment strategies, and ensuring access to mental health support for nurses in working conflict zones. These actions are essential for building a resilient nursing workforce capable of providing quality care amidst the unique challenges of armed conflict.

Parental non-compliance to childhood safety practices: A cross-sectional study.

Background & objectives To assess the pattern of non-compliance to childhood safety practices among parents of children between one and five yr of age and to determine the reasons behind the same. Methods A descriptive, cross-sectional study was conducted on 120 children between one and five yr of age through a questionnaire-based interview of the primary carer. Poor compliance was defined as compliance to <85 per cent of the recommended practices. Results Of the total 48 injuries, 32 were serious (66.6%). Falls and burns/scalds were the two common types of injuries. Nearly three-fourths (72.5%) of families showed overall poor compliance. Poorest compliance was observed towards four safety practices namely, helmet wearing, restricting number of pillion riders to two on a two-wheeler, seatbelt wearing in a car and avoiding food items with a high risk of choking in children <3 yr. Parental perception of 'unnecessary' and 'lack of knowledge' were the main reasons behind non-compliance. Interpretation & conclusions Low compliance among families occurred with respect to safety on motor vehicles and avoidance of choking hazards. Change of parental perception and improved awareness is necessary for the prevention of unintentional childhood injuries.

An improvement of the conceptual system of the sequential events model of road crashes (i-MOSES).

Background: The circulation of vehicles, motorized or not, is a risky activity that can lead to a traffic accident in which all road users can be affected. Road accidents generate high personal, labor, health and economic costs, as well as civil, administrative and even criminal responsibilities. Therefore, it is necessary to carry out a correct investigation of these road accidents. This paper reviews one of the models used for this investigation, the sequential events model for road crashes called MOSES. This model simplifies into a single sequential analysis the actions and conditions that have generated the occurrence and correlation of events that have led to a collision between two bodies, at least one of which is a vehicle, with harmful consequences for the environment, people and things. Methods: Analyzing the road accidents that occurred in the city of Badajoz between 2018 and 2022, this work proposes a new position of the sequential events in road accidents. This new position is present in more than fifty percent of the analyzed road accidents. How this new position can improve the description of traffic accidents is tested by analyzing an actual traffic accident recorded in the city of Badajoz between a motorcycle and a car. Results: The new position has been called Trust Position (TP) and is located between the Real Perception Position (RPP) and the Decision Enforcement Position (DEP) in the sequential events model for road crashes (i-MOSES). Furthermore, in this improvement of the MOSES model (i-MOSES), the reaction time (RT) is analyzed in more depth with the PIEV (Perception, Intellection, Emotion and Volition) theory, establishing that between RPP and TP are present the phases of perception and intellection, and between TP and DEP are present the phases of emotion and volition. Conclusions: This analysis shows how the proposed i-MOSES model allows for a deeper and more effective analysis of the causes that generated the traffic accident and all its circumstances. Moreover, it provides conclusions closer to the reality of how the accident actually happened and why it could have happened, ultimately leading to preventive measures to avoid future accidents.

Mapping the relationship between traffic accidents, road network configuration, and urban land use.

Understanding the nature of traffic accidents in relation to urban access networks is crucial for building safer and more resilient cities. This paper examines the issue of traffic accidents through the lenses of urban configurational theory and urban land use. Three data layers were used in the study, including space syntax analysis conducted in Depthmap X, geotagged traffic accidents collected by the police department, and geotagged land-use data. The method involved superimposing these data layers and exploring potential correlations using a geographic information system (GIS). The findings indicate significant correlations between the spatial frequency of traffic accidents and the choice measure (at 2500 m), local integration, and active land use. The findings of this study can help inform planners and policymakers about the best location to implement safety measures to reduce the risk of traffic accidents in urban access networks.

Efficacy of a Virtual Reality Rehabilitation Protocol Based on Art Therapy in Patients with Stroke: A Single-Blind Randomized Controlled Trial.

BACKGROUND: Art therapy has a long history of applications in cognitive and motor rehabilitation. More recently, a growing body of scientific literature has highlighted the potential of virtual reality in neurorehabilitation, though it has focused more on the technology itself than on the principles adopted in digital scenarios. METHODS: This study is a single-blind randomized controlled trial conducted on 40 patients with stroke, comparing conventional therapy (physical therapy for the upper and lower limbs, for posture and balance, cognitive therapy, occupational therapy, speech therapy, and specific therapy for swallowing, bowel, and bladder dysfunctions) to a protocol in which the upper limb physical therapy was substituted with art therapy administered by means of virtual reality exploiting the so-called Michelangelo effect. RESULTS: After 12 sessions, patients in the virtual art therapy group showed a significantly greater improvement in independence in activities of daily living, as assessed by the Barthel Index (interaction of time and group: p = 0.001). Significant differences were also found in terms of upper limb muscle strength (Manual Muscle Test, p < 0.01) and reduction in spasticity (Ashworth scale, p = 0.007) in favor of the experimental group. In the virtual art therapy group, the effectiveness of the intervention was significantly correlated with patient participation (Pittsburgh Rehabilitation Participation Scale: R = 0.41), patient satisfaction (R = 0.60), and the perceived utility of the intervention by the therapist (R = 0.43). CONCLUSIONS: These findings support the efficacy of virtual art therapy leveraging the Michelangelo effect. Further studies should also focus on cognitive domains that could benefit from this type of approach.