Caloric vestibular stimulation reduces pain and somatoparaphrenia in a severe chronic central post-stroke pain patient: a case study

Central post-stroke pain is a neuropathic syndrome characterized by intolerable contralesional pain and, in rare cases, somatic delusions. To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain. Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment. Following vestibular stimulation we observed impressive improvements in motor skills, pain, and somatic delusions. In the functional connectivity study before the vestibular stimulation, we observed differences in the patient's left thalamus functional connectivity, with respect to the thalamus connectivity of a control group (N = 20), in the bilateral cingulate cortex and left insula. After the caloric stimulation, the left thalamus functional connectivity with these regions, which are known to be involved in the cortical response to pain, disappeared as in the control group. The beneficial use of vestibular stimulation in the reduction of pain and somatic delusion in a CPSP patient is now documented by behavioral and imaging data. This evidence can be applied to theoretical models of pain and body delusions

Heart rate variability in response to the recall of attachment memories

Internal Working Models (IWM) of the attachment system are the devices by which individuals modulate emotional responses and the Disorganized attachment pattern is characterized by the breakdown of such emotion regulation. Vagally-mediated heart rate variability (vmHRV) is an index of regulated and flexible emotional responding. The current study aims at investigating vmHRV in non-clinical adults (n = 59; 29 males) with an Organized or Disorganized attachment pattern before, increase in vmHRV during the AAI which also persisted during the recovery phase. Results suggest that while Organized face the recollection of attachment memories by showing the adaptive stress response characterized by parasympathetic withdrawal and immediate recovery, individuals with Disorganized attachment need to keep regulating their emotions effortfully both during and after the recall of potential traumatic events

Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

Italian Version of the Pittsburgh Rehabilitation Participation Scale: Psychometric Analysis of Validity and Reliability

Patient’s active participation in therapy is a key component of successful rehabilitation. In fact, low participation has been shown to be a prognostic factor of poor outcome; however, participation is rarely assessed in clinical settings. The Pittsburgh Rehabilitation Participation Scale (PRPS) is a validated, quick, and accurate measure of participation, relying on clinicians’ observation, and not requiring any self-report by patients. The aim of this study was to validate an Italian version of the PRPS. Following forward and back-translation of PRPS into Italian, the translated version was validated in a total of 640 therapy sessions, related to a cohort of 32 patients admitted to an Italian hospital. It was tested for concurrent validity, finding significant correlations with Barthel Index (R > 0.58, p < 0.001) and SF-36 Physical and Mental Health (R > 0.4, p < 0.02), for predictive validity, finding significant correlation with the effectiveness of rehabilitation (R = 0.358, p = 0.045), and for inter-rater and intra-rater reliability, computing an Intra-class correlation coefficient (ICC = 0.926 and 0.756, respectively). These psychometric properties results were similar to those of the original version of this scale. The proposed PRPS can be helpful for Italian clinicians in the assessment of patient’s participation during rehabilitation

Manuale dei disturbi alimentari

I disturbi alimentari (DA) rappresentano una sfida stimolante sia per i clinici sia per il Sistema sanitario nazionale nel suo complesso, poiché pongono problemi che coinvolgono varie prospettive cliniche, sociali e culturali. Ciò ha reso necessaria la creazione di affiatate équipe multidisciplinari, nella consapevolezza che la cura dei da passi per una presa in carico integrata e complessa dei bisogni a livello sia psichico che somatico, sia personale che di sistema. Privilegiando un approccio multidisciplinare che illustri la complessità degli approcci alla cura dei da, il volume descrive la storia di questi disturbi e le loro forme cliniche, negli adulti e nell’età evolutiva; i sintomi alimentari, gli strumenti psicodiagnostici per valutarli, gli aspetti corporei, neuroscientifici e quelli più generali che sottendono il disturbo, e presenta infine i modelli di cura, senza trascurare gli aspetti medico-legali

Quando il cibo sano diventa un'ossessione

L'ortoressia nervosa è un'ossessione patologica per il cibo biologicamente puro che si manifesta con importanti restrizioni dietetiche, un'eccessiva preoccupazione per gli ingredienti e le tecniche utilizzate per la lavorazione del cibo, la diminuzione di relazioni sociali, l'isolamento e la malnutrizione. Nonostante il fenomeno sia diffuso a livello mondiale, non esistevano ancora testi in italiano sull'argomento. Il volume intende colmare questa lacuna descrivendo le conoscenze sinora acquisite sull'ortoressia nervosa, analizzando gli studi riconosciuti dalla comunità scientifica internazionale ed evidenziando le criticità che gravitano intorno a tale controversa scelta alimentare. Vengono trattate le basi psicologiche e sociali di questa nuova manifestazione clinica, il confronto tra l'ortoressia nervosa e altre psicopatologie e gli strumenti attualmente usati per la diagnosi. Inoltre si propone una concettualizzazione del fenomeno sia in termini psicopatologici sia come possibile risposta adattiva a stimoli ambientali

La valutazione con BADS

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