oxidative stress in post acute ischemic stroke patients relevance of early intensive neurorehabilitation

Oxidative stress was investigated in 10 post-acute stroke patients (median age 76.40 ± 2.09 years) assigned to in-hospital neurorehabilitation within 7 days of onset of a first-ever ischemic stroke. Assessments were made before and after neurorehabilitation. Outcome measures were the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index (BI), the Katz Index (KI), the modified Rankin Scale (mRS) and the modified PULSES profile. Differences between scores evaluated before and after neurorehabilitation were expressed as Δ scores. Oxidative stress was assessed by measuring plasma amount of total peroxides by-products, nitrite/nitrate metabolites (NOx), total plasma antioxidant capacity (TEAC), Cu/Zn Superoxide Dismutase (Cu/ZnSOD), and serum urate concentration. Ten healthy volunteers (median age 74.30 ± 3.03 years) were recruited as controls for comparison of oxidative markers. Neurorehabilitation was associated with an improvement (P<0.05) of all the outcome measures except the mRS score. ΔPULSES correlated negatively with ΔBI scores (r=-0.656; P=0.040). Higher plasma levels of total peroxidative by-products and NOx metabolites were found in stroke patients than in controls before neurorehabilitation (P<0.05). Their values decreased in stroke patients after neurorehabilitation and were higher than those measured in controls (P<0.05). TEAC, Cu/Zn SOD and serum urate levels were lower in stroke patients than in controls before neurorehabilitation (P<0.05). Their values increased after neurorehabilitation so that no differences were observed comparing these values with those found in controls. Changes observed before and after neurorehabilitation in plasma NOx amount (ΔNOx) correlated positively with ΔNIHSS scores (r=0.675; P=0.032) and negatively with ΔPULSES (r=- 0.845; P=0.002). Cu/ZnSOD changes found before and after neurorehabilitation (ΔCu/Zn SOD) and ΔKI correlated positively (r=0.713; P=0.021). Our results showed that intensive neurorehabilitation may modulate oxidative stress and suggest its effectiveness in redox-mediated plasticity processes involved in the recovery of stroke-induced neurological deficits

Computational rehabilitation of neglect:Using state-space models to understand the recovery mechanisms

Unilateral spatial neglect is a neuropsychological syndrome often observed in right hemisphere stroke patients. The symptoms differ from subject to subject. A few rehabilitation approaches, e.g. prism adaptation, have demonstrated some effect in reducing the symptoms, but the underlying mechanisms are still largely unclear. Recently, neural models have been proposed to qualitatively describe cortical lesions, the resulting neglect symptoms and the effects of treatment. However, these predictions are qualitative and cannot be used to compare different hypotheses or to interpret symptoms at individual subjects level. Here we propose a computational model of the trial-by-trial dynamics of training-induced recovery from neglect. Neglect is modelled in terms of an impaired internal representation of visual stimuli in the left hemispace. The model assumes that recovery is driven by the mismatch between defective representations of visual stimuli and the corresponding hand positions. The model reproduces the main observations of prism adaptation experiments. Using standard system identification techniques, we fitted the model to data from a rehabilitation trial based on a novel rehabilitation approach based on virtual reality, involving reaching movements within an adaptive environment. Our results suggest that the model can be used to interpret data from individual subjects and to formulate testable hypotheses on the mechanisms of recovery and directions for treatment

Computer-based cognitive rehabilitation: the CoRe system

This work aims at providing a tool for supporting cognitive rehabilitation. This is a wide field, that includes a variety of diseases and related clinical pictures; for this reason the need arises to have a tool available that overcomes the difficulties entailed by what currently is the most common approach, that is, the so-called pen and paper rehabilitation. Methods: We first organized a big number of stimuli in an ontology that represents concepts, attributes and a set of relationships among concepts. Stimuli may be words, sounds, 2D and 3D images. Then, we developed an engine that automatically generates exercises by exploiting that ontology. The design of exercises has been carried on in synergy with neuropsychologists and speech therapists. Solutions have been devised aimed at personalizing the exercises according to both patients’ preferences and performance. Results: Exercises addressed to rehabilitation of executive functions and aphasia-related diseases have been implemented. The system has been tested on both healthy volunteers (n 1/4 38) and patients (n 1/4 9), obtaining a favourable rating and suggestions for improvements. Conclusions: We created a tool able to automate the execution of cognitive rehabilitation tasks. We hope the variety and personalization of exercises will allow to increase compliance, particularly from elderly people, usually neither familiar with technology nor particularly willing to rely on it. The next step involves the creation of a telerehabilitation tool, to allow therapy sessions to be undergone from home, thus guaranteeing continuity of care and advantages in terms of time and costs for the patients and the National Healthcare System (NHS).Postprint (published version

Emotional dissonance and exhaustion among healthcare professionals: the role of the perceived quality of care

Objectives The aim of this exploratory study was to analyze the association between emotional dissonance and emotional exhaustion among healthcare professionals, and the mediating role of the perceived quality of care in this relationship. Material and Methods Self-report questionnaires were administered to 724 healthcare workers. The measurement model was tested and the mediation hypothesis was verified through hierarchical multiple regression analyses. Bootstrapping was used to construct confidence intervals to evaluate the mediation effects. Results Emotional dissonance was significantly related to emotional exhaustion, and the perceived quality of care was negatively related to emotional exhaustion. The perceived quality of care had a partial mediating effect on the relationship between emotional dissonance and emotional exhaustion. Emotional dissonance had a significant effect on emotional exhaustion, and the perceived quality of care was a mediating factor in this relationship among healthcare professionals. Conclusions The management of the perceived quality of care may be helpful in the prevention of burnout and distress in the workplace. Int J Occup Med Environ Health. 2019;32(6):841–5

Hand rehabilitation with sonification techniques in the subacute stage of stroke

After a stroke event, most survivors suffer from arm paresis, poor motor control and other disabilities that make activities of daily living difficult, severely affecting quality of life and personal independence. This randomized controlled trial aimed at evaluating the efficacy of a music-based sonification approach on upper limbs motor functions, quality of life and pain perceived during rehabilitation. The study involved 65 subacute stroke individuals during inpatient rehabilitation allocated into 2 groups which underwent usual care dayweek) respectively of standard upper extremity motor rehabilitation or upper extremity treatment with sonification techniques. The Fugl-Meyer Upper Extremity Scale, Box and Block Test and the Modified Ashworth Scale were used to perform motor assessment and the McGill Quality of Life-it and the Numerical Pain Rating Scale to assess quality of life and pain. The assessment was performed at baseline, after 2weeks, at the end of treatment and at follow-up (1month after the end of treatment). Total scores of the Fugl-Meyer Upper Extremity Scale (primary outcome measure) and hand and wrist sub scores, manual dexterity scores of the affected and unaffected limb in the Box and Block Test, pain scores of the Numerical Pain Rating Scale (secondary outcomes measures) significantly improved in the sonification group compared to the standard of care group (time*group interaction&lt;0.05). Our findings suggest that music-based sonification sessions can be considered an effective standardized intervention for the upper limb in subacute stroke rehabilitation

Clinical features and cognitive sequelae in COVID-19: a retrospective study on N=152 patients

Background: The novel human coronavirus (SARS-CoV-2) shows neurotropism and systemically affects the central nervous system (CNS). Cognitive deficits have been indeed reported as both short- and long-term sequelae of SARS-CoV-2 infection. However, the association between these disturbances and background/disease-related clinical features remains elusive. This work aimed at exploring how post-infective cognitive status relates to clinical/treatment outcomes by controlling for premorbid/current risk factors for cognitive deficits. Methods: Cognitive measures (Mini-Mental State Examination, MMSE) of N=152 COVID-19 patient were retrospectively assessed in relation to disease severity, intensive care unit (ICU) admission, steroidal treatment, and occurrence of other viral/bacterial infections by controlling for remote/recent/COVID-19-related risk factors for cognitive deficits (at-risk vs. not-at-risk: Neuro+ vs. Neuro−). Results: Descriptively, impaired MMSE performances were highly prevalent in mild-to-moderate patients (26.3%). ICU-admitted patients made less errors (p=.021) on the MMSE than those not admitted when partialling out risk factors and age—the latter negatively influencing performances. When addressing Neuro− patients only, steroidal treatment appears to improve MMSE scores among those suffering from other infections (p=.025). Discussion: Cognitive sequelae of COVID-19 are likely to arise from a complex interplay between background/clinical premorbid features and disease-related/interventional procedures and outcomes. Mild-to-moderate patients requiring assistive ventilation who however are not admitted to an ICU are more likely to suffer from cognitive deficits—despite their etiology remaining elusive

Quality of life of patients with spinal cord injury in Italy: preliminary evaluation

Quality of life is a complex concept, entailing the person's physical health and level of independence, as well as psychological well-being, social participation and the relationship with specific and relevant aspects of the environment. The World Health Organization encourages the integration of a comprehensive definition of health when examining patient-related outcomes after injury or disease. This study aims at evaluating the quality of life of 130 Italian patients with spinal cord injury, focusing on the associations among functional status and health dimensions elicited by SF-36 questionnaire. The subscale scores that revealed a stronger impact of the lesion were those related to the physical domains, especially for the physical functioning and physical role functioning. Physical functioning scores were significantly different in the acute phase with respect to chronic phase, in inpatients with respect to outpatients and in patients with lower functional impairment versus patients with higher functional impairment. Moreover, the functional impairment influenced significantly physical role, bodily pain and vitality scales. Disease phases also showed significantly different scores for general health. No differences were highlighted between tetraplegic and paraplegic patients

The mental representation of Verb\u2013Noun compounds in Italian: Evidence from a multiple single-case study in aphasia

This study seeks information on the mental representation of Verb\u2013Noun (VN) nominal compounds through neuropsychological methods. The lexical retrieval of compound nouns is tested in 30 aphasic patients using a visual confrontation naming task. The target names are VN compounds, Noun\u2013Noun (NN) compounds, and long morphologically simple nouns (LSN). In order to check the ability to produce simple nouns and verbs in the same participants, a further visual confrontation naming task of objects and actions is used. Results of the study confirm that several patients with disproportionate verb deficit are also impaired in naming VN com- pounds. Data are in favor of a (de)compositional processing of compound words. A further group of patients is selectively more impaired with compound nouns than with comparably long simple nouns, irrespective of their VN or NN morphological structure. It is suggested that this impairment is to be ascribed to a specific disorder in retrieving two different lexemes with a single lexical entry