Analysis of Italian regulations on pathways of care for patients in a vegetative or minimally conscious state.

Different rehabilitation models for persons diagnosed with disorders of consciousness have been proposed in Europe during the last decade. In Italy, the Ministry of Health has defined a national healthcare model, although, to date, there is a lack of information on how this has been implemented at regional level. The INCARICO project collected information on different regional regulations, analysing ethical aspects and mapping care facilities (numbers of beds and medical units) in eleven regional territories. The researchers found a total of 106 laws; differences emerged both between regions and versus the national model, showing that patients with the same diagnosis may follow different pathways of care. An ongoing cultural shift from a treatment-oriented medical approach towards a care-oriented integrated biopsychosocial approach was found in all the welfare and healthcare systems analysed. Future studies are needed to explore the relationship between healthcare systems and the quality of services provided.

Visual body recognition in a prosopagnosic patient.

Conspicuous deficits in face recognition characterize prosopagnosia. Information on whether agnosic deficits may extend to non-facial body parts is lacking. Here we report the neuropsychological description of FM, a patient affected by a complete deficit in face recognition in the presence of mild clinical signs of visual object agnosia. His deficit involves both overt and covert recognition of faces (i.e. recognition of familiar faces, but also categorization of faces for gender or age) as well as the visual mental imagery of faces. By means of a series of matching-to-sample tasks we investigated: (i) a possible association between prosopagnosia and disorders in visual body perception; (ii) the effect of the emotional content of stimuli on the visual discrimination of faces, bodies and objects; (iii) the existence of a dissociation between identity recognition and the emotional discrimination of faces and bodies. Our results document, for the first time, the co-occurrence of body agnosia, i.e. the visual inability to discriminate body forms and body actions, and prosopagnosia. Moreover, the results show better performance in the discrimination of emotional face and body expressions with respect to body identity and neutral actions. Since FM's lesions involve bilateral fusiform areas, it is unlikely that the amygdala-temporal projections explain the relative sparing of emotion discrimination performance. Indeed, the emotional content of the stimuli did not improve the discrimination of their identity. The results hint at the existence of two segregated brain networks involved in identity and emotional discrimination that are at least partially shared by face and body processing.

Voluntary regularization method of the respiratory act applied to chronic obstructive pulmonary disease.

Respiration is a vital, complex function, fundamentally automatic that can be modulated by will. The aim of the original method submitted is the progressive rehabilitation of the patient to strain, by a gradual reduction of respiratory frequency at the progressive increase in expiration phases and the execution of a growing effort in strict relation to the execution of the method itself. The patient learns to beat out the rhythm of his respiration based upon the strokes of the metronome, calibrated at 60 strokes a minute. The most evident documentation of the efficacy of our method of voluntary regularization of the respiratory act is in the evaluation of the effort capacity of each patient, before and after the method. The data are referred to the distance covered by cyclette, in standard conditions. The examined clinical parametres comprehend: cardiac frequency, respiratory frequency, maximal pause and arterial pressure. The laboratory parametres examined include the value of the arterial astrup: pH, pCO2, HCO3-, total CO2, pO2, excess basis. The scarcity of clinical survey examined during our research does not permit the formulation of any conclusive considerations, which would lead to a critical revision of the whole field of the physiology of respiration. For this reason, it is more prudent to establish the modifications of various parametres collected, until a more certain and wider confirmation is available.