On the relation between body and movement space representation: an experimental investigation on spinal cord injured people

Body Representation (BR) and Movement Space Perception (MSP) are fundamental for human beings in order to move in space and interact with object s and other people. Both BR and space representation change after spinal cord injuries in complete paraplegic individuals (CPP), who suffer from lower limbs paralysis and anesthesia. To date, the interaction between BR and MSP in paraplegic individuals rem ains unexplored. In two consecutive experiments, we tested I ) if the individual\u2019s wheelchair is embodied in BR; and ii) if the embodied wheelchair modifies the MSP. For the first question a speeded detection task was used. Participants had to respond to v isual stimuli flashing on their trunk, legs or wheelchair. In three counterbalanced conditions across participant, they took part to the experiment while: 1) sitting in their wheelchair, 2) in another wheelchair, or 3) with the LEDs on a wooden bar. To in dicate the embodiment, there was no difference in the CPP\u2019s responses for LEDs on the body and personal wheelchair while these were slower in other conditions After this, while sitting in their or another wheelchair, CPPs were asked to judge the slope of a ramp rendered in immersive virtual reality and to estimate the distance of a flag positioned over the ramp. When on their own wheelchair, CPPs perceived the flag closer than in the other wheelchair. These results indicate that the continuous use of a too l induces embodiment and that this i mpact on the perception of MSP

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Embodying their own wheelchair modifies extrapersonal space perception in people with spinal cord injury

Despite the many links between body representation, acting and perceiving the environment, no research has to date explored whether specific tool embodiment in conditions of sensorimotor deprivation influences extrapersonal space perception. We tested 20 spinal cord injured (SCI) individuals to investigate whether specific wheelchair embodiment interacts with extrapersonal space representation. As a measure of wheelchair embodiment, we used a Body View Enhancement Task in which participants (either sitting in their own wheelchair or in one which they had never used before) were asked to respond promptly to flashing lights presented on their above- and below-lesion body parts. Similar or slower reaction times (RT) to stimuli on the body and wheelchair indicate, respectively, the presence or absence of tool embodiment. The RTs showed that the participants embodied their own wheelchair but not the other one. Moreover, they coded their deprived lower limbs as external objects and, when not in their own wheelchair, also showed disownership of their intact upper limbs. To measure extrapersonal space perception, we used a novel, ad hoc designed paradigm in which the participants were asked to observe a 3D scenario by means of immersive virtual reality and estimate the distance of a flag positioned on a ramp. In healthy subjects, errors in estimation increased as the distance increased, suggesting that they mentally represent the physical distance. The same occurred with the SCI participants, but only when they were in their own wheelchair. The results demonstrate for the first time that tool embodiment modifies extrapersonal space estimations

Long-term facial improvement after repeated BoNT-A injections and mirror biofeedback exercises for chronic facial synkinesis: a case-series study

BACKGROUND: Only few studies have considered the effects of the combined treatment with onabotulinumtoxinA (BoNT-A) injections and biofeedback (BFB) rehabilitation in the recovery of postparetic facial synkinesis (PPFS). AIM: To explore the presence of a persistent improvement in facial function out of the pharmacological effect of BoNT-A in subjects with established PPFS, after repeated sessions of BoNT-A injections combined with an educational facial training program using mirror biofeedback (BFB) exercises. Secondary objective was to investigate the trend of the presumed persistent improvement. STUDY DESIGN: Case-series study. SETTING: Outpatient Clinic of Physical Medicine and Rehabilitation Unit. POPULATION: Twenty-seven patients (22 females; mean age 45±16 years) affected by an established peripheral facial palsy, treated with a minimum of three BoNT-A injections in association with mirror BFB rehabilitation. The interval between consecutive BoNT-A injections was at least five months. METHODS: At baseline and before every BoNT-A injection+mirror BFB session (when the effect of the previous BoNT-A injection had vanished), patients were assessed with the Italian version of Sunnybrook Facial Grading System (SB). The statistical analysis considered SB composite and partial scores before each treatment session compared to the baseline scores. RESULTS: A significant improvement of the SB composite and partial scores was observed until the fourth session. Considering the "Symmetry of Voluntary Movement" partial score, the main improvement was observed in the muscles of the lower part of the face. CONCLUSIONS: In a chronic stage of postparetic facial synkinesis, patients may benefit from a combined therapy with repeated BoNT-A injections and an educational facial training program with mirror BFB exercises, gaining an improvement of the facial function up to the fourth session. This improvement reflects the acquired ability to use facial muscle correctly. It doesn't involve the injected muscles but those trained with mirror biofeedback exercises and it persists also when BoNT-A action has vanished. CLINICAL REHABILITATION IMPACT: The combined therapy with repeated BoNT-A injections and an educational facial training program using mirror BFB exercises may be useful in the motor recovery of the muscles of the lower part of the face not injected but traine

Una metodica innovativa per la valutazione quantitativa di abilità visuomotorie

Le abilità visuomotorie sono alla base di una vasta gamma di azioni quotidiane. La corretta programmazione del recupero di pazienti che, a seguito di menomazioni a carico del sistema nervoso centrale, subiscono una compromissione di tali abilità, richiede lo sviluppo di sistemi di valutazione in grado di stabilire quantitativamente quale dei livelli di organizzazione del sistema visuomotorio sia coinvolto. Basandoci sulle assunzioni proposte agli inizi degli anni Novanta da Milner e Goodale riguardo all’esistenza di due vie di processamento dell’informazione visiva (ventral stream e dorsal stream) che interagiscono nella pianificazione e nella programmazione del movimento, il nostro studio si è proposto di validare l’utilizzo di una metodica in grado di valutare quantitativamente e selettivamente le abilità percettive e visuomotorie connesse, rispettivamente, a tali vie. Diciannove soggetti non patologici destrimani (età media 22.8 anni ±3.18) hanno partecipato all’esperimento. Sono state somministrate prove di puntamento ritardato, di pantomima di distanza ritardata e di indicazione della posizione opposta a quella ricordata sull’asse orizzontale per la valutazione del ventral stream; prove di afferramento e di puntamento immediato per la valutazione del dorsal stream. Le varie prove sono state filmate ed elaborate con il software di videoanalisi Dartfish ProSuite. L’analisi statistica dei risultati ha confermato vari pattern già noti in letteratura tra cui la predominanza attenzionale per i campi visivi in alto a sinistra, la predominanza del tono flessorio nei movimenti dell’arto superiore eseguiti nello spazio peripersonale prossimale, la tendenza a sovrastimare distanze ridotte e a sottostimare distanze maggiori, l’evitamento di stimoli di riferimento. Pertanto possiamo concludere che la metodica è affidabile ed è resa vantaggiosa dalle caratteristiche di relativa semplicità e completa trasportabilit

Developmental writing disorders: assessment for rehabilitation

Writing ability requires to use and control several processes of visual and phonological information processing and an adequate programming and coordination of motor sequences. We studied a writing precursor gesture in children with Developmental Dysorthography and/or Developmental Dysgraphia in order to point out anomalies to be treated with specific rehabilitative interventions