Virtual reality rehabilitation program on executive functions of children with specific learning disorders: a pilot study.

Background: The application of Virtual Reality (VR) in the field of rehabilitation has been widely studied, because it has already proven to be an effective intervention for a variety of physical and cognitive conditions. Nevertheless, its application in pediatric rehabilitation is more recent. This pilot study aims to examine whether a VR-rehabilitation program may have positive effects on the Executive Functions (EFs) of children with Specific Learning Disorders (SLD). Materials and methods: Twenty-four children with diagnosis of SLD participated to the study (range 7-11 years) and performed the VR-training across 6 weeks in the CARE Lab, that was designed with appropriate structural measures and ad hoc fittings, to hide the sophisticated technology necessary to allow the child to experience a rehabilitative setting with recreational and semi-immersive features. Children were evaluated across three main time-points: T0, assessment of cognitive level and EFs immediately before the start of the intervention; T1, assessment of EFs immediately after the end of VR intervention; T2, follow-up of EFs after 6 months from the end of the VR intervention. The rehabilitation programs were customized according to clinical needs and/or single patient's characteristics, proposing different games with variable complexity levels. Results: Results showed that scores for visual attention, inhibition, flexibility, and planning abilities were significantly higher than before the intervention, and the most part of these ameliorations were maintained after 6 months. Conclusion: These findings provide important inputs for the development of new innovative rehabilitation interventions for children with SLD that must be founded in ecological and evidence-based approaches.

Open organ preservation surgery of the larynx: Experience of Istituto Nazionale Tumori of Milan.

BACKGROUND: The purpose of the present study was to report the oncological and functional results of our experience in open organ preservation surgery of the larynx. METHODS: Between 1978 and 2006, 140 patients were treated with organ preservation surgery of the larynx. Feeding tube and tracheotomy duration, surgical infection, fistulae, and pneumonia were recorded. RESULTS: Most patients were treated with supraglottic laryngectomies. Thirteen patients (9%) experienced a faringo-cutaneous fistula, 23 (16%) presented with a surgical site infection, and 6 (4%) developed pneumonia. Tracheotomy was maintained for a median period of 47 days in patients who did not receive postoperative radiotherapy (RT) and 140 days in patients who did. Eight (6%) total laryngectomies were performed because of oncological and functional reasons. Tube feeding continued for an average period of 34 days. Patients with squamous cell carcinoma (SCC) had 5-year disease-free survival (DFS) of 83.6%. CONCLUSION: Open organ preservation surgery proved oncologically effective with good functional outcome and acceptable complications.

Schwannoma in the parotid gland. Experience at our institute and review of the literature.

Schwannoma of the parotid gland is an uncommon tumor. When the facial nerve is involved by the tumor at the time of the operation, the surgical approach requires careful evaluation. The purpose of this study is to provide indications which can support the decision, taking into account the different clinical presentations of parotid schwannoma. In a retrospective study, eight cases of parotid schwannoma were collected between 1975 and 2006. In three cases the tumor affected the facial nerve itself and in the remaining ones it originated from intraparotid nonfacial peripheral nerves. When the facial nerve is involved by the tumor a conservative approach should always be considered. The indication for a surgical procedure should be discussed with the patient. If a conservative strategy is chosen, yearly follow-up by means of MRI and clinical observation should be planned.