Intensive Care Admission and Early Neuro-Rehabilitation. Lessons for COVID-19?

Coronavirus disease 2019 (COVID-19) requires admission to intensive care (ICU) for the management of acute respiratory distress syndrome in about 5% of cases. Although our understanding of COVID-19 is still incomplete, a growing body of evidence is indicating potential direct deleterious effects on the central and peripheral nervous systems. Indeed, complex and long-lasting physical, cognitive, and functional impairments have often been observed after COVID-19. Early (defined as during and immediately after ICU discharge) rehabilitative interventions are fundamental for reducing the neurological burden of a disease that already heavily affects lung function with pulmonary fibrosis as a possible long-term consequence. In addition, ameliorating neuromuscular weakness with early rehabilitation would improve the efficiency of respiratory function as respiratory muscle atrophy worsens lung capacity. This review briefly summarizes the polymorphic burden of COVID-19 and addresses possible early interventions that could minimize the neurological and systemic impact. In fact, the benefits of early multidisciplinary rehabilitation after an ICU stay have been shown to be advantageous in several clinical conditions making an early rehabilitative approach generalizable and desirable to physicians from a wide range of different specialties

Parity and Time Reversal in the Spin-Rotation Interaction

A recently reported discrepancy between experimental and theoretical values of the muon's g-2 factor is interpreted as due to small violations of the conservation of P and T in the spin-rotation coupling. The experiments place an upper limit on these violations and on the weight change of spinning gyroscopes.Comment: 3 page

A Focus on Subtle Signs and Motor Behavior to Unveil Awareness in Unresponsive Brain-Impaired Patients: The Importance of Being Clinical.

Brain-injured patients in a state of cognitive motor dissociation (CMD) exhibit a lack of command following using conventional neurobehavioral examination tools but a high level of awareness and language processing when assessed using advanced imaging and electrophysiology techniques. Because of their behavioral unresponsiveness, patients with CMD may seem clinically indistinguishable from those with a true disorder of consciousness that affects awareness on a substantial level (coma, vegetative state/unresponsive wakefulness state, or minimally conscious state minus). Yet, by expanding the range of motor testing across limb, facial, and ocular motricity, we may detect subtle, purposeful movements even in the subset of patients classified as vegetative state/unresponsive wakefulness state. We propose the term of clinical CMD to describe patients showing these slight but determined motor responses and exhibiting a characteristic akinetic motor behavior as opposed to a pyramidal motor system behavior. These patients may harbor hidden cognitive capabilities and significant potential for a good long-term outcome. Indeed, we envision CMD as ranging from complete (no motor response) to partial (subtle clinical motor response) forms, falling within a spectrum of progressively better motor output in patients with considerable cognitive capabilities. In addition to providing a decisional flowchart, we present this novel approach to classification as a graphical model that illustrates the range of clinical manifestations and recovery trajectories fundamentally differentiating true disorders of consciousness from the spectrum of CMD

Spin-gravity coupling and gravity-induced quantum phases

External gravitational fields induce phase factors in the wave functions of particles. The phases are exact to first order in the background gravitational field, are manifestly covariant and gauge invariant and provide a useful tool for the study of spin-gravity coupling and of the optics of particles in gravitational or inertial fields. We discuss the role that spin-gravity coupling plays in particular problems.Comment: 18 pages, 1 figur

Functional imaging to uncover willful brain behavior in noncommunicative patients

SCOPUS: ed.jinfo:eu-repo/semantics/publishe

The application of a mathematical model linking structural and functional connectomes in severe brain injury

Following severe injuries that result in disorders of consciousness, recovery can occur over many months or years post-injury. While post-injury synaptogenesis, axonal sprouting and functional reorganization are known to occur, the network-level processes underlying recovery are poorly understood. Here, we test a network-level functional rerouting hypothesis in recovery of patients with disorders of consciousness following severe brain injury. This hypothesis states that the brain recovers from injury by restoring normal functional connections via alternate structural pathways that circumvent impaired white matter connections. The so-called network diffusion model, which relates an individual's structural and functional connectomes by assuming that functional activation diffuses along structural pathways, is used here to capture this functional rerouting. We jointly examined functional and structural connectomes extracted from MRIs of 12 healthy and 16 brain-injured subjects. Connectome properties were quantified via graph theoretic measures and network diffusion model parameters. While a few graph metrics showed groupwise differences, they did not correlate with patients' level of consciousness as measured by the Coma Recovery Scale — Revised. There was, however, a strong and significant partial Pearson's correlation (accounting for age and years post-injury) between level of consciousness and network diffusion model propagation time (r = 0.76, p < 0.05, corrected), i.e. the time functional activation spends traversing the structural network. We concluded that functional rerouting via alternate (and less efficient) pathways leads to increases in network diffusion model propagation time. Simulations of injury and recovery in healthy connectomes confirmed these results. This work establishes the feasibility for using the network diffusion model to capture network-level mechanisms in recovery of consciousness after severe brain injury

Dynamic inter-regional coordination patterns as specific predictors of consciousness

Background and aims: To date, specific signatures of conscious states in humans remain elusive. Contemporary theories concur that such markers can be traced to temporally evolving brain processes instead of static descriptions of brain activity. Methods: Dynamic fMRI connectivity patterns (states) by means of clustering of phase-based coherence was estimated on 47 healthy and 112 patients diagnosed in vegetative state/unresponsive wakefulness syndrome (VS/UWS) or in a minimally conscious state (MCS). To validate whether the patterns captured properties of awareness, out-of-sample generalization was performed on patients with cognitive-motor dissociation (i.e. lacking overt conscious behaviour yet evidenced using functional neuroimaging), and on anesthetised patients, under the premise that complex signatures would disappear uniformly across all subjects. Results: A pattern of long-range positive/negative coherence had a higher probability of occurring in healthy and MCS patients. A pattern of low inter-areal coordination, mostly similar to anatomy, was more likely to occur in VS/UWS. Inter-state transitioning was flexible for healthy and MCS and more rigid for VS/UWS patients. Unconscious patients were more likely to avoid the exploration of the complex connectivity state. The generalization to cognitive-motor dissociation predicted the occurrence of the complexconnectivity state. The generalization to propofol anaesthesia showed an equalization of occurrence probabilities of all patterns regardless of clinical diagnosis. Conclusion: The dynamics of inter-areal coordination contain information specific to conscious awareness. The rigid and less metastable dynamics in VS/UWS could account for the limited mental capacities in these patients. The minute identification of these patterns and their external manipulation could account for non-invasive restoration of consciousness