Limb apraxia in individuals with multiple sclerosis: Is there a role of semi-immersive virtual reality in treating the Cinderella of neuropsychology?

BACKGROUND: Limb apraxia is an acquired cognitive-motor disorder characterized by spatial and temporal disorganization of limb movements, negatively affecting the quality of life of patients, including those with multiple sclerosis (MS). Although recent studies have shown the potential role of VR in increasing cognitive and motor functions, only a few studies have been carried out on the rehabilitation of upper limb apraxia. Hence, our study aims to evaluate the potential efficacy of VR training to improve upper limb ideomotor apraxia in patients with MS. METHODS: One hundred and six patients, affected by secondary progressive MS, who attended our Robotic and Behavioral Neurorehabilitation Service from March 2019 to February 2020, were enrolled in this study and randomly divided into two groups: the control group (CG: 53 patients) performed traditional therapy whereas the experimental group (EG:53 patients) received training using semi-immersive VR. All patients underwent the same amount of cognitive training, 3 times a week for 8 weeks. They were submitted to a specific neuropsychological assessment before (T0) and after the rehabilitation treatment (T1). RESULTS: The VR training led to a significant improvement in global cognitive functions, with regard to constructive and ideomotor apraxia. On the contrary, the CG achieved significant improvements only in ideomotor apraxia. Moreover, only in the EG, we observed an improvement in the mood at the end of training. CONCLUSION: The present study demonstrates that VR rehabilitation can be an effective tool for the treatment of apraxia, which is a neuropsychological problem often underestimated in MS patients. Further studies with long-term follow-up periods are needed to confirm the effect of this promising approach.

Cognitive rehabilitation outcomes in patients with Multiple sclerosis: Preliminary data about the potential role of personality traits.

Background Multiple Sclerosis (MS) can be associated with personality changes. Personality traits affect the cognitive functions, mood, and psychological well-being of people with MS and their families. Objective The aim of this study was to evaluate whether personality traits might be predictors of cognitive recovery in people with MS. Methods. Thirty-one patients with a diagnosis of MS were enrolled in this study. Each participant was evaluated by a neuropsychologist before (T0) and after the end of the rehabilitation treatment (T1). The Five-Factor Model (FFM) has been used to describe the basic personality structure by highlighting five personality traits: extroversion, neuroticism, conscientiousness, agreeableness, and openness. The rehabilitation program included conventional physiotherapy, speech therapy, psychological support, cognitive rehabilitation, and nutritional therapy as well as robotic rehabilitation, advanced cognitive rehabilitation, and virtual reality. Logistic regressions are carried out to measure the changes score between T0 and T1. Results The results showed that patients had significant improvement in cognitive and behavioral functioning. Here, we considered the relationships between the scores of cognitive and emotional/behavioral domains, the five scales of the BFQ, besides the psychiatric symptoms. In particular, the mental quality of life, visuospatial and verbal long-term memory were positively influenced by the agreeableness trait, while depression was negatively affected by this trait. Conclusion Our data suggest that personality traits could influence cognitive and behavioral recovery in patients with MS.

Social cognition in patients with acquired brain lesions: An overview on an under-reported problem.

Social cognition (SC) consists of mental representations of interpersonal relationships, which are used flexibly by the individual to promote functional social behaviors and achieve the goals. SC is a multidimensional construct and is supported by the activity of distributed neural networks in which different cortical and subcortical regions of the brain are involved. The review aims to evaluate the current literature on SC taking into account how it is compromised in acquired brain injury. Studies performed between 2010 and 2019 and fulfilling the selected criteria were searched on PubMed, Scopus, Cochrane and Web of Sciences databases. Impairment of SC is a neglected but common consequence of ABI, often leading to disordered interpersonal functioning and poor regulation of personal behavior with impaired social adaptation and quality of life of both the patient and his/her family. This review supports the idea that SC could have an important role in the management of neurological patients by both clinicians and caregivers.

What about the Consequences of the Use of Distance Learning during the COVID-19 Pandemic? A Survey on the Psychological Effects in Both Children and Parents.

BACKGROUND: The COVID-19 pandemic implicated many social restrictions, including the use of distance learning (DL). Indeed, parents were obligated to support their children in online lessons and schoolwork. The aim of this study was to investigate the psycho-emotional impact of the COVID-19 pandemic on parents and children submitted to DL. METHODS: One hundred and ninety-two participants (96 parents and 96 children) were enrolled in this study. Parents and children completed an online questionnaire, structured in four sections. RESULTS: The results showed that parents had higher levels of stress and anxiety. In particular, the stress for DL was positively correlated with depression and anxiety. Parents' jobs were negatively correlated with their levels of anxiety and stress. On the other hand, children reported higher levels of depressive symptoms and event-related anxiety, which increased as children got older. The stress and the anxiety in parents were positively correlated with the mood depression and anxiety of their children. CONCLUSIONS: The COVID-19 pandemic had a negative impact on the psychological well-being of children and parents who used DL. Although DL could be an alternative teaching method during pandemics, face-to-face teaching is fundamental and irreplaceable as it encourages dialogue, involvement, and human contact.

Is intensive gait training feasible and effective at old age? A retrospective case-control study on the use of Lokomat Free-D in patients with chronic stroke.

BACKGROUND: In the last decade, the number of people over 60 has increased, leading to various healthcare problems. The aim of this retrospective study is to evaluate the effects of robotic rehabilitation in elderly patients as well as their perception of usability and adaptation to intensive robotic neurorehabilitation. METHODS: This is a retrospective case-control study. Eighty elderly stroke patients were included in the analysis using an electronic data retrieval system. The enrolled patients were divided into two groups: the experimental group (EG) underwent rehabilitation training with Lokomat FreeD, equipped with a VR screen, while the control group (CG) performed traditional rehabilitation training. The two groups matched for age, sex, education, brain injury, stroke interval. The rehabilitation protocol included a total of 40 training sessions. RESULTS: Both types of rehabilitation led to an improvement in the perceived level of disability (FIM) and in the performance in gait and balance (TT), highlighting a significant improvement especially in the EG. However, only in the EG, Lokomat training had induced an increase in the distance covered in 10 min (10 m walk test), and a significant improvement in mood (HRS-D). Moreover, Lokomat-FreeD was well tolerated by patients with high levels of usability. CONCLUSIONS: Our results suggest that elderly patients may benefit from high-intensity robotic neurorehabilitation using the Lokomat-Pro FreeD.

Effects of domotics on cognitive, social and personal functioning in patients with chronic stroke: A pilot study.

BACKGROUND: Stroke can cause severe brain lesions, leading to multiple cognitive, emotional and motor disorders. In fact, it is one of the main causes of death and disability worldwide, with a negative impact on quality of life for both patient and caregiver. Home automation (also known as domotics) could allow stroke patients to manage and improve their daily lives. OBJECTIVE: The aim of our pilot study was to evaluate the effects of domotics on cognitive functions and personal/social autonomy in patients with stroke. METHODS: We enrolled 40 patients affected by chronic stroke undergoing neurorehabilitation at IRCCS Centro Neurolesi (Messina, Italy), between June 2017 and March 2019. All of the patients were randomized into either the control group (undergoing traditional training based on face-to-face interaction between therapist and patient, and practical activities), or the experimental group (undergoing Home Automation training). Each participant was evaluated before and immediately after the training period. Each different training consisted of 3 sessions per week for eight weeks (i.e. a total of 24 sessions), each session lasting about 60 min. For both the conventional and experimental trainings, treatments were performed in groups, and all the patients were provided with the same amount of treatment. RESULTS: Patients in the experimental group showed a greater improvement in cognitive and social performance, as compared to the control group. CONCLUSION: Our study shows that domotics could be effective in improving social and cognitive functioning, autonomy and functional recovery in patients affected by chronic stroke.

Toward Improving Poststroke Aphasia: A Pilot Study on the Growing Use of Telerehabilitation for the Continuity of Care.

BACKGROUND: Aphasia is a quite common and very disabling symptom following stroke, negatively affecting patient's quality of life. Aim of the study is to evaluate the effectiveness of a rehabilitation training for aphasia that employ a touch-screen tablet using a virtual reality rehabilitation system (VRRS-Tablet). MATERIAL AND METHODS: Thirty patients with aphasia due to ischemic or hemorrhagic stroke were randomized into either the control or the experimental group and assessed by means of a specific neuropsychological evaluation. The study lasted 6 months and included 2 phases. During the former, the experimental group underwent an experimental linguistic treatment performed using the VRRS-Tablet, while the control group was trained with a traditional linguistic treatment. In the latter, the control groups were delivered to territorial services, while the experimental group was provided with the VRRS-Tablet. RESULTS: The experimental group improves in all the investigated areas, except for writing, while the control group only improves in comprehension, depression, and quality of life. CONCLUSIONS: Our study has demonstrated the effectiveness of a home-based telerehabilitation program specific for poststroke aphasia. The use of telerehabilitation by means of VRRS-Tablet could be one of the best solutions to treat aphasic patients after their discharge, promoting continuity of care by monitoring functional outcomes, maintaining preserved abilities, reducing depression, and improving linguistic functions, besides the psychological well-being.

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.