Improvement of brain functional connectivity in autism spectrum disorder: an exploratory study on the potential use of virtual reality.

Patients with Autism Spectrum Disorder (ASD) need to be provided with behavioral, psychological, educational, or skill-building interventions as early as possible. Cognitive Behavior Therapy has proven useful to manage such problems. There is also growing evidence on the usefulness of Virtual Reality Therapy (VRT) in treating various functional deficits in ASD. This exploratory study is aimed at assessing the changes in cognitive functions in children with ASD, and the putative subtending neurophysiological mechanisms, following the provision of rehab training using an innovative VRT system. Twenty patients with ASD, aged 6-15 years, were provided with 24 sessions of VRT by using the pediatric module of the BTS NIRVANA System. Neuropsychological and EEG evaluations were carried out before and at the end of the training. After VRT, all patients showed a significant improvement in their cognitive-behavioral problems concerning attention processes, visuospatial cognition, and anxiety. These findings were paralleled by an evident reshape of frontoparietal connectivity in the alpha and theta frequency range. Our study suggests that VRT could be a useful and promising tool to improve ASD neurorehabilitation outcomes. This improvement is likely to occur through changes in frontoparietal network connectivity following VRT.

Innovative use of virtual reality in autism spectrum disorder: A case-study.

Autism Spectrum Disorders (ASDs) are developmental disorders affecting communication and behavior. ASD incidence in the world population is about 1%, with a 4:1 ratio between males and females. In clinical practice, ASDs have been usually treated with cognitive-behavioral approaches, involving a face-to-face interaction with the therapist. Over the last years, virtual reality (VR) has played an important role in neurorehabilitation, even for ASD cognitive treatment. A 16-year-old boy with severe ASD and his caregiver were enrolled in the study. Two different cognitive trainings were administered; first, the boy was submitted to one-month cognitive behavioral therapy (CBT); then, after one month of rest, a combined approach using VR (by means of the BTS-Nirvana System) and CBT was applied. Only the combined approach provided an improvement in attention processes and spatial cognition skills, with a significant reduction of ideomotor stereotypes. According to this experience, the use of VR in addition to CBT could be a useful and promising tool to improve cognitive function in individuals severely affected by ASD.

Brain functional connectivity in chronic tic disorders and Gilles de la Tourette syndrome.

The pathophysiology of chronic tic disorder (cTD) and Gilles de la Tourette syndrome (GTS) is characterized by the dysfunction of both motor and non - motor cortico - striatal - thalamo - cortical (CSTC) circuitries, which leads to tic release and comorbids. A role of fronto - parietal network (FPN) connectivity breakdown has been postulated for tic pathogenesis, given that the FPN entertain connections with limbic, paralimbic, and CSTC networks. Our study was aimed at characterizing the FPN functional connectivity in cTD and GTS in order to assess the role of its deterioration in tic severity and the degree of comorbids. We recorded scalp EEG during resting state in patients with cTD and GTS. The eLORETA current source densities were analyzed, and the lagged phase synchronization (LPS) was calculated to estimate nonlinear functional connectivity between cortical areas. We found that the FPN functional connectivity in delta band was more detrimental in more severe GTS patients. Also, the sensorimotor functional connectivity in beta2 band was stronger in more severe cTD and GTS patients. FPN functional connectivity deterioration correlated with comorbids presence and severity in patients with GTS. Our data suggest that a FPN disconnection may contribute to the motoric symptomatology and comorbid severity in GTS, whereas sensorimotor disconnection may contribute to tic severity in cTD and GTS. Although preliminary, our study points out a differently disturbed brain connectivity between patients with cTD and GTS. This may serve as diagnostic marker and potentially interesting base to develop pharmacological and noninvasive neuromodulation trials aimed at reducing tic symptomatology.

Cognitive rehabilitation using immersive virtual reality at young age: A case report on traumatic brain injury.

Adolescents having moderate to severe traumatic brain injury (TBI) often experience long-lasting cognitive, emotional, and behavioral problems. In current clinical practice, rehabilitation techniques to treat cognitive abnormalities may be classified in two main categories, i.e. conventional or advanced. Aim of this case study was to evaluate the safety and efficacy of an immersive virtual environment (Computer Assisted Rehabilitation Environment [CAREN]), in a young boy affected by severe TBI. A 15-year-old boy with TBI involving the right parietal-temporal region underwent two different rehabilitation trainings, including standard cognitive rehabilitation alone in a usual clinical setting (face-to-face intervention with a paper and pencil approach) or the same cognitive program using virtual scenarios by means of CAREN. We evaluated the patient's cognitive status, before and after the two different trainings, by using a specific psychometric battery to evaluate the cognitive and behavioral functioning, such as attention abilities, visuo-spatial and executive functions. Only at the end of the CAREN training, we observed a significant improvement in specific cognitive and motor domains, such as attention abilities, visuo-executive processes, emotional awareness, and balance. Cognitive training, using immersive Virtual Reality, may be a useful tool to facilitate cognitive recovery in TBI patients.

Impulse control disorders in Parkinson's disease: A systematic review on risk factors and pathophysiology.

AIM: Purpose of this review is to evaluate the potential risk factors that may predispose to the development of Impulse control disorders (ICDs) in Parkinson's Disease (PD) patients, including the effects of dopaminergic therapy. METHODS: This descriptive review was conducted to identificate risk factors that could cause impulsive control disorders in PD. Studies were found on PubMed (2010-2018), Web Of Science (January 2010-July 2018) and Cochrane (2010-2018) databases. RESULTS: The data suggest that intrinsic and extrinsic factors may be involved in the development of behavioral complications. To date, the link between PD and the development of ICDs is not very clear, but studies highlight the existence of a predisposition to ICDs in the presence of risk factors. CONCLUSIONS: A better assessment of the behavioral disorders of PD may be useful in the rehabilitative intervention for increasing the quality of life.