Post-traumatic olfactory dysfunction: a scoping review of assessment and rehabilitation approaches

Post-traumatic Olfactory Dysfunction (PTOD) consists of a complete or partial loss of olfactory function that may occur after a traumatic brain injury (TBI). PTOD may be linked to some neuropsychiatric features, such as social, cognitive and executive dysfunction, as well as behavioral symptoms, especially when TBI involves the orbito-frontal cortex. The diagnosis of PTOD is based on medical history and clinical data and it is supported by psychometric tests (i.e., subjective tools) as well as electrophysiological and neuroimaging measures (i.e., objective methods). The assessment methods allow monitoring the changes in olfactory function over time and help to establish the right therapeutic and rehabilitative approach. In this context, the use of the olfactory training (OT), which is a non-pharmacological and non-invasive treatment option, could promote olfactory function through top-down (central) and bottom-up (peripheral) processes. To better manage patients with TBI, PTOD should be detected early and properly treated using the various therapeutic rehabilitative possibilities, both conventional and advanced, also taking into consideration the emerging neuromodulation approach

Bridging the Gap between Basic Research and Clinical Practice: The Growing Role of Translational Neurorehabilitation

Translational neuroscience is intended as a holistic approach in the field of brain disorders, starting from the basic research of cerebral morphology and with the function of implementing it into clinical practice. This concept can be applied to the rehabilitation field to promote promising results that positively influence the patient’s quality of life. The last decades have seen great scientific and technological improvements in the field of neurorehabilitation. In this paper, we discuss the main issues related to translational neurorehabilitation, from basic research to current clinical practice, and we also suggest possible future scenarios

Robot-Aided Motion Analysis in Neurorehabilitation: Benefits and Challenges

In the neurorehabilitation field, robot-aided motion analysis (R-AMA) could be helpful for two main reasons: (1) it allows the registration and monitoring of patients’ motion parameters in a more accurate way than clinical scales (clinical purpose), and (2) the multitude of data produced using R-AMA can be used to build machine learning algorithms, detecting prognostic and predictive factors for better motor outcomes (research purpose). Despite their potential in clinical settings, robotic assessment tools have not gained widespread clinical acceptance. Some barriers remain to their clinical adoption, such as their reliability and validity compared to the existing standardized scales. In this narrative review, we sought to investigate the usefulness of R-AMA systems in patients affected by neurological disorders. We found that the most used R-AMA tools are the Lokomat (an exoskeleton device used for gait and balance rehabilitation) and the Armeo (both Power and Spring, used for the rehabilitation of upper limb impairment). The motion analysis provided by these robotic devices was used to tailor rehabilitation sessions based on the objective quantification of patients’ functional abilities. Spinal cord injury and stroke patients were the most investigated individuals with these common exoskeletons. Research on the use of robotics as an assessment tool should be fostered, taking into account the biomechanical parameters able to predict the accuracy of movements

Psychological and Cognitive Effects of Long COVID: A Narrative Review Focusing on the Assessment and Rehabilitative Approach

Long COVID is a clinical syndrome characterized by profound fatigue, neurocognitive difficulties, muscle pain, weakness, and depression, lasting beyond the 3–12 weeks following infection with SARS-CoV-2. Among the symptoms, neurocognitive and psychiatric sequelae, including attention and memory alterations, as well as anxiety and depression symptoms, have become major targets of current healthcare providers given the significant public health impact. In this context, assessment tools play a crucial role in the early screening of cognitive alterations due to Long COVID. Among others, the general cognitive assessment tools, such as the Montreal Cognitive assessment, and more specific ones, including the State Trait Inventory of Cognitive Fatigue and the Digit Span, may be of help in investigating the main neurocognitive alterations. Moreover, appropriate neurorehabilitative programs using specific methods and techniques (conventional and/or advanced) through a multidisciplinary team are required to treat COVID-19-related cognitive and behavioral abnormalities. In this narrative review, we sought to describe the main neurocognitive and psychiatric symptoms as well as to provide some clinical advice for the assessment and treatment of Long COVID

Improving Outcomes in People with Spinal Cord Injury: Encouraging Results from a Multidisciplinary Advanced Rehabilitation Pathway

Spinal cord injury (SCI) consists of damage to any segment of the spinal cord extending to potential harm to nerves in the cauda equina. Rehabilitative efforts for SCI can involve conventional physiotherapy, innovative technologies, as well as cognitive treatment and psychological support. The aim of this study is to evaluate the feasibility of a dedicated, multidisciplinary, and integrated intervention path for SCI, encompassing both conventional and technological interventions, while observing their impact on cognitive, motor, and behavioral outcomes and the overall quality of life for individuals with SCI. Forty-two patients with SCI were included in the analysis utilizing electronic recovery system data. The treatment regimen included multidisciplinary rehabilitation approaches, such as traditional physiotherapy sessions, speech therapy, psychological support, robotic devices, advanced cognitive rehabilitation, and other interventions. Pre–post comparisons showed a significant improvement in lower limb function (Fugl Meyer Assessment-FMA p p p < 0.001). In addition, we assessed patient satisfaction using the Short Form of the Patient Satisfaction Questionnaire (PSQ), offering insights into the subjective evaluation of the intervention. In conclusion, this retrospective study provides positive results in terms of improvements in motor function, cognitive functions, and quality of life, highlighting the importance of exploring multidisciplinary approaches

Psycho-Neuroendocrinology in the Rehabilitation Field: Focus on the Complex Interplay between Stress and Pain

Chronic stress and chronic pain share neuro-anatomical, endocrinological, and biological features. However, stress prepares the body for challenging situations or mitigates tissue damage, while pain is an unpleasant sensation due to nociceptive receptor stimulation. When pain is chronic, it might lead to an allostatic overload in the body and brain due to the chronic dysregulation of the physiological systems that are normally involved in adapting to environmental challenges. Managing stress and chronic pain (CP) in neurorehabilitation presents a significant challenge for healthcare professionals and researchers, as there is no definitive and effective solution for these issues. Patients suffering from neurological disorders often complain of CP, which significantly reduces their quality of life. The aim of this narrative review is to examine the correlation between stress and pain and their potential negative impact on the rehabilitation process. Moreover, we described the most relevant interventions used to manage stress and pain in the neurological population. In conclusion, this review sheds light on the connection between chronic stress and chronic pain and their impact on the neurorehabilitation pathway. Our results emphasize the need for tailored rehabilitation protocols to effectively manage pain, improve treatment adherence, and ensure comprehensive patient care

Improvement of Gait after Robotic-Assisted Training in Children with Cerebral Palsy: Are We Heading in the Right Direction?

Cerebral palsy (CP) is a non-progressive congenital neurological disorder that affects different physical and cognitive functions in children. In addition to standard rehabilitation, advanced robotic gait devices are novel tools that are becoming progressively more common as part of the treatment of CP. The aim of this study is to evaluate the effects of Lokomat training, in addition to conventional rehabilitation, on the motor function and quality of life of children with ataxic-spastic CP (ASCP). Ten children with ASCP who attended the Robotic Rehabilitation OutClinic of the IRCCS Centro Neurolesi &ldquo;Bonino Pulejo&rdquo;, from April to June 2019, were enrolled in this study. They received twenty-four robotic rehabilitation sessions, twice a week for three months, each session lasting about 45 min. They were also provided with conventional physical and occupational therapy. After the innovative training, we found significant changes in the children&rsquo;s outcomes, i.e., in GMFM (p &lt; 0.001), with significant improvements in sitting (p &lt; 0.03) and walking (p &lt; 0.03). Moreover, the quality of life of the young patients, evaluated by their parents, significantly improved (p &lt; 0.005). The use of robotic systems could be considered to be an effective complementary treatment to improve gait, as well as quality of life, in children with CP

Moving toward Appropriate Motor Assessment Tools in People Affected by Severe Acquired Brain Injury: A Scoping Review with Clinical Advices

Severe acquired brain injury (SABI) is among the leading causes of death and disability worldwide. Patients following SABI may develop motor, sensory and cognitive disorders, alone or in combination. This review aims to point out the most used scales to assess motor function in SABI patients, also attempting to give some indications on their applicability in clinical practice. Studies were identified by searching on PubMed, Web of Science, PeDro and Cochrane databases between January and March 2022. We found that motor assessment tools are currently used by researchers/clinicians either in the acute/post-acute phase (for prognosis and rehabilitation purposes) or in the chronic phase (when functional items may also be considered). Moreover, specific scales exist only for patients with disorders of consciousness, whereas regarding motor function, SABI is mainly assessed by adapting the tools commonly used for stroke. Although some doubts remain about the validity of some of these assessment tools in SABI, to investigate motor outcomes is fundamental to establish a correct prognosis and plan a tailored rehabilitation training in these very frail and vulnerable patients

Innovative Technologies in the Neurorehabilitation of Traumatic Brain Injury: A Systematic Review

Motor and cognitive rehabilitation in individuals with traumatic brain injury (TBI) is a growing field of clinical and research interest. In fact, novel rehabilitative approaches allow a very early verticalization and gait training through robotic devices and other innovative tools boosting neuroplasticity, thanks to the high-intensity, repetitive and task-oriented training. In the same way, cognitive rehabilitation is also evolving towards advanced interventions using virtual reality (VR), computer-based approaches, telerehabilitation and neuromodulation devices. This review aimed to systematically investigate the existing evidence concerning the role of innovative technologies in the motor and cognitive neurorehabilitation of TBI patients. We searched and reviewed the studies published in the Cochrane Library, PEDro, PubMed and Scopus between January 2012 and September 2022. After an accurate screening, only 29 papers were included in this review. This systematic review has demonstrated the beneficial role of innovative technologies when applied to cognitive rehabilitation in patients with TBI, while evidence of their effect on motor rehabilitation in this patient population is poor and still controversial

Benefits of Telerehabilitation for Patients With Severe Acquired Brain Injury: Promising Results From a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality

BackgroundIn neurorehabilitation, the use of innovative technologies offers many opportunities to monitor and improve the health status of patients with severe acquired brain injury (SABI). Telerehabilitation allows for continuity of service through the entire rehabilitation cycle, including assessment, intervention, consultation, and education, affording early reintegration and positively enhancing the quality of life (QoL). ObjectiveThe main purpose of this multicenter randomized controlled trial was to test the effectiveness of advanced training provided using a nonimmersive virtual reality rehabilitation system (ie, the VRRS HomeKit device) in improving functional outcomes in patients with SABI. MethodsIn total, 40 patients with SABI and their 40 caregivers visiting 2 Italian rehabilitation centers were enrolled in the study protocol and randomized into 2 groups. Of the 40 patients, 20 (50%) underwent the experimental training using the VRRS HomeKit (teleneuro-VRRS group), whereas the other 20 (50%) were administered usual territorial rehabilitative treatments (UTRTs; control group). To investigate motor and neuropsychological functioning, patients with SABI were evaluated before (T0) and at the end of (T1) each training session by a multispecialist team through a complete clinical and psychometric battery: the Barthel Index (BI), the Tinetti Scale (TS), the Modified Ashworth Scale (MAS), the Montreal Cognitive Assessment (MoCa), the Frontal Assessment Battery (FAB), the Beck Depression Inventory II (BDI-II), the Short Form Health Survey 36 (SF-36), and the Psychological General Well-Being Index (PGWBI). In addition, the Caregiver Burden Inventory (CBI) was administered to each caregiver to investigate the emotional burden status. ResultsThe teleneuro-VRRS group achieved a statistically significant improvement in both general and motor outcomes, as well as psychological well-being and QoL, compared to the control group. In particular, the BI (P<.001), FAB (P<.001), and BDI-II (P<.001) were the outcome scales with the best improvement. The burden of caregivers also significantly improved in the teleneuro-VRRS group (CBI; P<.004). Between-group analysis showed statistical differences in the anxiety (effect size [ES]=0.85, P<.02) and self-control (ES=0.40, P<.03) subtests of the PGWBI and in the social role functioning (ES=0.85, P<.02) subtest of the SF-36, confirmed by quite medium and large ESs. ConclusionsOur results suggest that the VRRS is a suitable alternative tool or complementary tool or both to improve motor (level of functional independence) and cognitive (frontal/executive abilities) outcomes, reducing behavioral alterations (anxiety and depression symptoms) in patients with SABI, with a beneficial impact also on the caregivers’ burden distress management, mitigating distress and promoting positive aspects of caring. Trial RegistrationClinicalTrials.gov NCT03709875; https://classic.clinicaltrials.gov/ct2/show/NCT0370987