Computerized Training in Poststroke Aphasia: What About the Long-Term Effects? A Randomized Clinical Trial.

BACKGROUND: Poststroke aphasia is a very disabling disorder, which may affect speech expression, comprehension, and reading or writing. Treatment of aphasia should be initiated as soon as possible after the brain injury; however, the improvement of language functions can occur also in the chronic phase. MATERIALS AND METHODS: Thirty-two patients were randomly assigned to either an experimental group (17 patients) treated with computerized rehabilitation training (Power-Afa, Maddaloni, Campania, Italy) or a control group (15 patients), submitted to conventional speech therapy. Patients were trained 3 times a week for 8 weeks, (i.e., 24 sessions of 45 minutes each), and assessed at baseline (T0), at the end of each training (T1), and 3 months after the end of the treatment (T2). RESULTS: The experimental group had a significant improvement from T0 to T1 in all the outcomes, whereas for the control group patients such an improvement was significant only concerning Functional Independence Measure and ideomotor praxis. Notably, the improvements in cognitive and language functions were maintained at 3-month follow-up only in the experimental group. CONCLUSIONS: The software Power-Afa can be considered a valuable tool in improving the linguistic and cognitive recovery in patients affected by poststroke aphasia in the chronic phase. Further studies with larger samples and longer follow-up periods are needed to confirm such promising findings.

Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial.

OBJECTIVE: The objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke. METHODS: 50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training. RESULTS: The AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p < 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p < 0.001) and a greater rebalance between the SAI of both the hemispheres (p < 0.001). CONCLUSIONS: These data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group. SIGNIFICANCE: These results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.

The Use of a Hypoallergenic Dermal Matrix for Wrapping in Peripheral Nerve Lesions Regeneration: Functional and Quantitative Morphological Analysis in an Experimental Animal Model.

INTRODUCTION: The aim of this research was to test, in an animal model, the nerve regeneration technique with a hypoallergenic acellular dermal matrix used to wrap the microsurgical neural suture. MATERIALS AND METHODS: Two groups of rats received the cut of limb right median nerves. The regeneration technique considers for both groups an end-to-end nerve suture. In the experimental group (A) was used also a wrapping protocol by a conduit of collagen matrix currently used in oral surgery. The animals underwent functional grasping tests (at 1, 3, 5, and 7 months) and a histological and quantitative analysis of distal nerve was performed at the end of experimental time. RESULT: After seven months, the grasping test reveals functional recovery in each tested animal; this improvement is more evident in Group A. The fibers appear well organized with restored myelin sheaths in both groups. Group A showed a great quantity of connective tissue surrounding the nerve. The quantitative morphology analysis in both groups shows a similar fibers density, fiber diameter, and myelin thickness. The differences between the groups in axon mean diameter are significant. In Group A M/d, D/d, and g-ratio is significantly higher compared to control group. CONCLUSIONS: Histological and functional assessments show a functional recovery of the injured nerve in the test groups, stressed by the results of the grasping tests and the meaningful increasing in fiber diameter and higher g-ratio. Moreover, a connective tissue cuff distinguishes the distal portion of the injured nerve. Considering the easy availability and handling of the material used in this study we can conclude that this experimental technique can be considered as a valid alternative to protect nerves in nerve wrap surgery.

The Growing Use of Virtual Reality in Cognitive Rehabilitation: Fact, Fake or Vision? A Scoping Review.

OBJECTIVE: This review aims to evaluate the role of Virtual Reality (VR) in cognitive rehabilitation of different neurological diseases, and the accessibility to healthcare systems providing this type of treatment. METHOD OF RESEARCH: Studies performed between 2003 and 2017 and fulfilling the selected criteria were found on PubMed, Scopus, Cochrane and Web of Sciences databases. The search combined the terms VR rehabilitation with different neurological disease. RESULTS: Our findings showed that neurological patients performed significant improvement in many cognitive domains (executive and visual-spatial abilities; speech, attention and memory skills) following the use of VR training. CONCLUSIONS: This review supports the idea that rehabilitation through new VR tools could positively affect neurological patients' outcomes, by boosting motivation and participation so to get a better response to treatment. In particular, VR can be used to enhance the effects of conventional therapies, promoting longer training sessions and a reduction in overall hospitalization time.

Counseling children and parents about epilepsy.

In spite of remarkable progress in drug therapy, childhood and adolescent epilepsy is often a distressing condition lasting several years before possible recovery. Adaptation problems to the disease, and also to health recovery, are likely to occur. Stigma and discrimination may persist also after recovery. Learning problems involve a high number of patients. Neuropsychological problems related to localization of the epileptic focus may be present; intellectual deterioration in more severe cases and in some specific syndromes may occur. These problems are not unknown, but therapeutic effort is often directed only towards seizure control. The importance of counseling children and parents is stressed by the authors, and practical advice is given on planning doctor-patient dialogues, in order to prevent non-justified restrictions in day life, fears and negative reactions, and to ameliorate intrafamilial relation, integration in the school milieu and compliance towards drug intake. The role of neuropsychological evaluation and pedagogic advice is also emphasized. Children and adolescents with epilepsy and their families need more than medical therapeutic support to get an acceptable quality of life.

[The birth of neuro-psychomotor therapy of developmental age]. / Esperienza e formazione nella terapia della neuro e psicomotricità dell'età evolutiva: la nascita di una professione e di una metodologia riabilitativa.

The article reconstruct the development of NPMTDA (Neuro-Psychomotor Therapy of Developmental Age) at the University 'La Sapienza' of Rome, where Giovanni Bollea created a team of childhood and adolescence Neuropsychiatry. In the Fifties three physiotherapists coming form the U.S.A., expert in physical, occupational and speech therapy, were the first trainers of roman therapists. Their assessment scheme was adapted to the needs of neuropsychiatric disorders and gradually the above mentioned practices flowed into both evaluation and therapeutic method, thanks also to the competence of other NPCA specialists. A rehabilitation school officially dedicated to children started only in 1973, though it had existed informally since the beginning. It progressively increased in academic dignity finally becoming, in 2000, a graduate school. The professional progress of therapists was favoured by medical advances, National Health Service institution (in the 70's), territorial spreading of rehabilitation centres, academic evolution of NPMTDA teaching.