Recovery from tactile agnosia: a single case study.

In a patient suffering from tactile agnosia a comparison was made (using the ABABAB paradigm) between three blocks of neuropsychological rehabilitation sessions involving off-line anodal transcranial direct current stimulation (anodal-tDCS) and three blocks of rehabilitation sessions without tDCS. During the blocks with anodal-tDCS, the stimulation was administered in counterbalanced order to two sites: i) the perilesional parietal area (specific stimulation) and ii) an occipital area far from the lesion (nonspecific stimulation).Rehabilitation associated with anodal-tDCS (in particular in the perilesional areas) is more efficacious than without stimulation.

Embodying their own wheelchair modifies extrapersonal space perception in people with spinal cord injury.

Despite the many links between body representation, acting and perceiving the environment, no research has to date explored whether specific tool embodiment in conditions of sensorimotor deprivation influences extrapersonal space perception. We tested 20 spinal cord injured (SCI) individuals to investigate whether specific wheelchair embodiment interacts with extrapersonal space representation. As a measure of wheelchair embodiment, we used a Body View Enhancement Task in which participants (either sitting in their own wheelchair or in one which they had never used before) were asked to respond promptly to flashing lights presented on their above- and below-lesion body parts. Similar or slower reaction times (RT) to stimuli on the body and wheelchair indicate, respectively, the presence or absence of tool embodiment. The RTs showed that the participants embodied their own wheelchair but not the other one. Moreover, they coded their deprived lower limbs as external objects and, when not in their own wheelchair, also showed disownership of their intact upper limbs. To measure extrapersonal space perception, we used a novel, ad hoc designed paradigm in which the participants were asked to observe a 3D scenario by means of immersive virtual reality and estimate the distance of a flag positioned on a ramp. In healthy subjects, errors in estimation increased as the distance increased, suggesting that they mentally represent the physical distance. The same occurred with the SCI participants, but only when they were in their own wheelchair. The results demonstrate for the first time that tool embodiment modifies extrapersonal space estimations.

Corporeal illusions in chronic spinal cord injuries.

While several studies have investigated corporeal illusions in patients who have suffered from a stroke or undergone an amputation, only anecdotal or single case reports have explored this phenomenon after spinal cord injury. Here we examine various different types of bodily misperceptions in a comparatively large group of 49 people with spinal cord injury in the post-acute and chronic phases after the traumatic lesion onset. An extensive battery of questionnaires concerning a variety of body related feelings was administered and the results were correlated to the main clinical variables. Six different typologies of Corporeal Illusion emerged: Sensations of Body Loss; Body-Part Misperceptions; Somatoparaphrenia-like sensations; Disownership-like sensations; Illusory motion and Misoplegia. All of these (with the exception of Misoplegia) are modulated by clinical variables such as pain (visceral, neuropathic and musculoskeletal), completeness of the lesion, level of the lesion and the length of time since lesion onset. In contrast, no significant correlations between bodily illusions and personality variables were found. These results support data indicating that at least some cognitive functions (in particular the body, action and space representations) are embodied and that somatosensory input and motor output may be necessary to build and maintain a typical self-body representation.

Early rehabilitation: benefits in patients with severe acquired brain injury.

Establish the best time to start rehabilitation by means of scientific evidence. Observational study in patients with a diagnosis of Severe Brain Injury who received intensive inpatient rehabilitation after acute care. 1470 subjects enrolled: 651 with Traumatic Brain Injury (TBI) and 819 with Non-TBI. Male gender was prevalent in the population study, but sex distribution was not different among groups, with a prevalence of male gender in both populations. This project involved 29 rehabilitation facilities for Severe ABI. The registry was an electronic database, remained active only during the period of data collection. The patients were divided into three different categories according to the time interval from brain injury to inpatient rehabilitation admission and demographic and clinical data were collected. Etiology, time interval from injury to inpatient rehabilitation, disability severity, the presence of tracheostomy at admission to the rehabilitation facility, rehabilitation length of stay and transfer back to acute care wards because of medical, surgical or neurosurgical complications. The interval from brain injury to rehabilitation facilities admission increases along with age, brain injury severity according to DRS scores, the presence of a tracheal tube and the percentage of transfers back to acute care wards from rehabilitation facilities, because of medical, surgical or neurosurgical complications. The better recovery and more positive outcomes, reported as resulting from early rehabilitation, may be due more to less severity of brain injury and fewer complications in the acute and post-acute phase than to when the rehabilitation starts.

VRT (verbal reasoning test): a new test for assessment of verbal reasoning. Test realization and Italian normative data from a multicentric study.

Verbal reasoning is a complex, multicomponent function, which involves activation of functional processes and neural circuits distributed in both brain hemispheres. Thus, this ability is often impaired after brain injury. The aim of the present study is to describe the construction of a new verbal reasoning test (VRT) for patients with brain injury and to provide normative values in a sample of healthy Italian participants. Three hundred and eighty healthy Italian subjects (193 women and 187 men) of different ages (range 16-75 years) and educational level (primary school to postgraduate degree) underwent the VRT. VRT is composed of seven subtests, investigating seven different domains. Multiple linear regression analysis revealed a significant effect of age and education on the participants' performance in terms of both VRT total score and all seven subtest scores. No gender effect was found. A correction grid for raw scores was built from the linear equation derived from the scores. Inferential cut-off scores were estimated using a non-parametric technique, and equivalent scores were computed. We also provided a grid for the correction of results by z scores.

Another perspective on anosognosia: Self-observation in video replay improves motor awareness.

Anosognosia for hemiplegia (AHP), or unawareness of motor deficits contralateral to a brain lesion, has lasting negative implications for the management and rehabilitation of patients. A recent, bedside psychophysical intervention, namely self-observation by video replay, lead to a lasting remission of severe AHP in an acute stroke patient (Fotopoulou, A., Rudd, A., Holmes, P., & Kopelman, M. (2009). Self-observation reinstates motor awareness in anosognosia for hemiplegia. Neuropsychologia, 47, 1256-1260). This procedure has been adjusted and applied here, as the basis of two intervention protocols administered independently to two patients with severe AHP. The first study used multiple, successive sessions of video-based self-observation in an acute patient, targeting first the awareness of upper limb and subsequently lower limb paralysis. The second study used a single session of video-based, self- and other-observation in a patient at the chronic stage following onset. Both protocols also involved elements of rapport building and emotional support. The results revealed that video-based self-observation had dramatic, immediate effects on awareness in both acute and chronic stages and it seemed to act as an initial trigger for eventual symptom remission. Nevertheless, these effects did not automatically generalise to all functional domains. This study provides provisional support that video-based self-observation may be included in wider rehabilitation programmes for the management and restoration of anosognosia.

Factors predicting functional and cognitive recovery following severe traumatic, anoxic, and cerebrovascular brain damage.

OBJECTIVES: To compare demographic data, clinical data, and rate of functional and cognitive recovery in patients with severe traumatic, cerebrovascular, or anoxic acquired brain injury (ABI) and to identify factors predicting discharge home. PARTICIPANTS: Three hundred twenty-nine patients with severe ABI (192 with traumatic, 104 with cerebrovascular, and 33 with anoxic brain injury). DESIGN: Longitudinal prospective study of inpatients attending the intensive Rehabilitation Department of the "Sacro Cuore" Don Calabria Hospital (Negrar, Verona, Italy). MAIN MEASURES: Etiology, sex, age, rehabilitation admission interval, rehabilitation length of stay, discharge destination, Glasgow Coma Scale, Disability Rating Scale (DRS), Glasgow Outcome Scale, Levels of Cognitive Functioning, and Functional Independence Measure. RESULTS: Predominant etiology was traumatic; male gender was prevalent in all the etiologic groups; patients with traumatic brain injury were younger than the patients in the other groups and had shorter rehabilitation admission interval, greater functional and cognitive outcomes on all considered scales, and a higher frequency of returning home. Patients with anoxic brain injury achieved the lowest grade of functional and cognitive recovery. Age, etiology, and admission DRS score predicted return home. CONCLUSIONS: Patients with traumatic brain injury achieved greater functional and cognitive improvements than patients with cerebrovascular and anoxic ABI. Age, etiology, and admission DRS score can assist in predicting discharge destination.

The role of F-18 FDG PET/CT in the prognosis of patients with hypoxic/anoxic brain injury after cardio-circulatory arrest.

BACKGROUND: Advances in resuscitation techniques have resulted in more patients surviving cardio-circulatory arrest (CA) and consequently developing hypoxic/anoxic brain damage. The aim of this study is to evaluate the role of PET/CT (Positron Emission Tomography/Computerized Tomography scan) with F-18 FDG (F-18 fluorodeoxyglucose) during the early rehabilitative hospitalization phase in determining the V/C (Vermis/Cerebellar) ratio as a prognostic index to predict patient outcome, as defined by clinical evaluation scales. METHODS: This is a single-center retrospective study of 37 consecutive adult patients admitted to the neurorehabilitation center between January 2011 and June 2019. Functional status was measured by the following clinical scales: FIM (Functional Indipendence Measure), LCFS (Levels of Cognitive Functioning Scale), GOS (Glasgow Outcome Scale) and CRS-R (Coma Recovery Scale-Revised). PET/CT with F-18 FDG as a functional imaging technique was used to calculate the V/C ratio as a ratio between the metabolism of the vermis and of the Cerebellar Hemisphere. RESULTS: A statistically significant correlation was observed between the V/C ratio and the delta values (difference between discharge and admission value) for each clinical evaluation scale (Delta FIM: P=0.0014; Delta LCFS P=0.0003). A statistically significant difference was observed between the V/C ratio of patients with LCFS ≥4 that showed an improved outcome (defined as an improvement of at least two points in LCFS), and that of patients with LCFS <4 that did not improve (P=0.0011). A V/C ratio cut-off of 1.5 corresponded with a positive predictive power of 80% and a negative predictive power of 82%; a value <1.5 predicted a better outcome. CONCLUSIONS: Clinical evaluation scales when associated with F-18 FDG PET/CT measurement of metabolism, provide a more reliable prognosis. This allows for more focused rehabilitation treatment and better management of family members' expectation.

A novel treatment for malignant spasticity: The therapeutic use of stereotactic radiosurgery (SRS).

Spasticity is a clinical condition secondary to central nervous system damage, which impairs patients' mobility and quality of life. Stereotactic radiosurgery (SRS) to the spinal roots responsible of the spasms might represent a non-invasive therapy. The present are the preliminary results of the first clinical use of this novel technique.

iColon, a patient-focused mobile application for perioperative care in colorectal surgery: an observational, real-world study protocol.

INTRODUCTION: The enhanced recovery after surgery (ERAS) protocol provides optimised care guidelines for patients undergoing elective colorectal surgery. To ensure high compliance with active ERAS elements, patients must be educated to actively participate in the perioperative care pathway. Mobile health is a rapidly expanding area of the digital health sector that is effective in educating and engaging patients during follow-up. iColon is a mobile application designed by the Operative Unit of General Surgery of IRCCS Sacro Cuore Don Calabria Hospital of Negrar of Valpolicella, which is specifically targeted at patients undergoing elective colorectal surgery. iColon is organised into ERAS phases, and it provides real-time feedback to surgeons about a patient's adherence to perioperative active ERAS elements. METHODS AND ANALYSIS: We hypothesise that by providing a patient-focused mobile application, compliance with active ERAS elements could be improved.The first coprimary objective is to build patient confidence in using the mobile application, iColon, during perioperative care. The second coprimary objective is to establish patient compliance with active ERAS elements.Secondary objectives include examining: length of stay, 30-day readmission rate, postoperative complications and patient satisfaction of received care.This study is a prospective observational real-world study of patients undergoing elective colorectal surgery who are following the ERAS protocol and using iColon during perioperative periods between September 2020 and December 2022.By educating and engaging patients in the ERAS protocol, the mobile application, iColon, should stimulate patients to be more proactive in managing their healthcare by complying more closely with active ERAS elements. ETHICS AND DISSEMINATION: This study has been approved by the local Ethics Committee with the protocol number 29219 of 25 May 2020. The results will be actively disseminated through peer-reviewed journals, conference presentations and various community engagement activities.