Long-term services for the care and rehabilitation of people with severe acquired brain injury: a multicentre, cross-sectional study of 536 Italian families.

BACKGROUND: People with severe acquired brain injuries (ABIs) require complex, long-term multidisciplinary healthcare, and social welfare programmes, and their families experience social and emotional consequences that profoundly condition their quality of life. OBJECTIVE: To investigate whether the possibility of gaining access to local rehabilitation and other services positively influences not only the quality of life of the patients but also the quality of life of their families. METHODS: The sample consisted of 536 families of patients with severe ABIs. They were administered a specific 50-item questionnaire with a mix of multiple choice answers, dichotomous (yes/no) answers, or answers based on a Likert-type scale. RESULTS: The results suggest that the long-term services provided to patients are substantially satisfactory but the data concerning the patients' social and working reintegration are discomforting. Furthermore, the families experience profound social discomfort related to their economic, emotional and caregiving burden regardless of the number and quality of the rehabilitation services activated, or the amount of welfare support received. CONCLUSIONS: Post-severe ABI services provided at a local level should include not only long-term rehabilitative and social support for the patients, but also long-term social and psychological support for their families.

From intention to perception: The case of anosognosia for hemiplegia.

Brain-damaged patients with anosognosia for hemiplegia deny their motor deficit and believe they can still move the paralyzed limb. Previous studies suggest that anosognosia can arise from intact motor intentionality and planning for the plegic hand. However, few studies focused on the relationship between this spared intentionality and perception. To further investigate this topic, we used an apparent motion paradigm, where a stimulus generated an ambiguous motion and participants were simply asked to judge its direction (right or left). We confirmed that, when healthy participants are asked to press a key either with their right or left hand, triggering the apparent motion, they show a perceptual bias toward the direction of the moving hand. Both bimanual and unimanual modalities (i.e. key pressing with-both-hands or with-one-hand, respectively) of the same apparent motion paradigm were administered to two groups of healthy participants. Interestingly, only in the bimanual modality, participants showed a significant perceptual bias. Hemiplegic patients with and without anosognosia, were requested to perform the bimanual task. Patients without anosognosia, fully aware of their left motor deficit, only programed right hand movements, behaving similarly to healthy controls performing the unimanual task. On the contrary, in patients with anosognosia, an effective motor intentionality for the left (plegic) hand influenced visual perception, giving rise to similar perceptual bias as that found in healthy controls actually performing bimanual movements. These findings suggest that having a specific motor representation can lead to different outcomes in the perception of the outside world.

Role of premorbid factors in predicting safe return to driving after severe TBI.

PRIMARY OBJECTIVE: The present study explored the possibility of predicting post-injury fitness to safe driving in patients with severe traumatic brain injury (TBI) (n = 66). METHODS AND PROCEDURE: Sixteen different measures, derived from four domains (demo/biographic, medico-functional, neuropsychological, and psychosocial) were used as predictor variables, whereas driving outcomes were assessed in terms of driving status (post-TBI drivers versus non-drivers) and driving safety (number of post-TBI car accidents and violations). MAIN OUTCOMES AND RESULTS: About 50% of the patients resumed driving after TBI. Compared to post-TBI non-drivers, post-injury drivers had shorter coma duration. With regard to driving safety, the final multiple regression model combined four predictors (years post-injury, accidents and violations before TBI, pre-TBI-risky-personality-index, and pre-TBI-risky-driving-style-index) and explained 72.5% of variance in the outcome measure. CONCLUSIONS: Since the best three predictors of post-injury driving safety addressed patients' premorbid factors, the results suggest that in order to evaluate the actual possibility of safe driving after TBI, it would be advisable to consider carefully patients' pre-TBI histories.