Search Results (90)

Background: Acquired brain injury (ABI) often disrupts binocular vision, causing deviations on the cover test and reduced stereopsis that impair functional visual performance. This study investigated the effects of a dichoptic vision therapy protocol—based on an immersive virtual reality (VR) system—on visual field parameters, oculomotor reaction times, and self-reported visual symptoms in adults with ABI. Methods: In a controlled parallel-group design, adult ABI patients (median age 51 years) were assigned to an experimental group (dichoptic VR therapy) or a control group. Six sessions of visual therapy were performed. Primary outcomes included perimetric visual field indices and oculomotor reaction times; the secondary outcome was the Brain Injury Vision Symptom Survey (BIVSS) score. Etiology (stroke vs. traumatic brain injury) was recorded. Results: No statistically significant improvements were found in perimetric visual field indices (p > 0.05), except for a slight gain in the top-right quadrant in the experimental group. Reaction times did not differ significantly between groups. However, the experimental group reported a greater reduction in visual symptoms as measured by the BIVSS. Patients with traumatic brain injury exhibited better functional improvement, particularly in the top-left quadrant (p = 0.04). Conclusions: Dichoptic VR-based therapy did not restore perimetric field losses in ABI patients but reduced visual symptoms and may enhance functional adaptation of residual vision rather than structural recovery. The therapeutic response varied by etiology, favoring traumatic brain injury. Larger, longer trials integrating objective and subjective measures, including neuroimaging, are warranted. Full article

Background: Acquired brain injury (ABI) affects manual dexterity (MD) and cognitive functions, limiting daily activity performance. Occupational therapy aims to improve functionality and quality of life. Objective: To examine and describe the available evidence on the impact of MD training on cognitive processes and functional performance in adults with stroke, as well as to identify the most commonly used assessment tools and intervention techniques. Methods: Scoping review. A systematic literature search was conducted in PubMed and Scopus to identify experimental studies from the last 10 years involving adults with ABI who participated in interventions targeting upper-limb, MD, and cognitive function. A three-phase screening was carried out by two authors with duplicates removed using Zotero version 7.0. Results: Ten articles published between 2016 and 2023 were included. The most frequent interventions involved robotics and virtual reality. Eight studies were conducted by occupational therapists or included occupational therapy involvement, while two were conducted by physiotherapists. Training MD and upper-limb motor skills led to improvements in attention, memory, and executive functions. Conclusions: Findings support combined motor–cognitive interventions carried out by occupational therapists or physiotherapists to optimize rehabilitation outcomes, although further research is needed to strengthen the evidence. Full article

Background/Objectives: This study aimed to characterize objective sleep measures in subacute acquired brain injury (ABI) and examine if disturbed sleep is associated with poor recovery outcomes. Another objective was to compare the functional connectivity of the brain between ABI poor sleepers and ABI normal sleepers as measured by resting state functional magnetic resonance imaging (rs-fMRI). Methods: This was a pilot, prospective, observational study of ABI subjects compared with age and gender-matched healthy controls. A total of 27 ABI subjects (consisting of ischemic or haemorrhagic stroke, or traumatic injury) were recruited from the outpatient clinics of a tertiary hospital with a neurological centre, and 49 healthy controls were recruited by word-of-mouth referrals. Study procedure involved subjective and objective sleep measures, self-report psychological measures, cognitive tests, and structural and functional MRI of the brain. Results: The frequency of poor-quality sleep was 66.67% in the ABI group and not significantly different from 67.35% in the control group when compared by chi-squared test (p = 0.68). ABI subjects with poor sleep had worse performance on a test of sustained attention (Colour Trails Test 1) than healthy controls with poor sleep when compared by Student’s t-test (mean 55.95 s, SD ± 18.48 vs. mean 40.04 s, SD ± 14.31, p = 0.01). Anxious ABI subjects have poorer sleep efficiency and greater time spent awake after sleep onset (WASO). ABI-poor sleepers show significantly greater functional connectivity within a frontoparietal network and bilateral cerebellum. Conclusions: Sleep problems after ABI are associated with poorer cognitive and psychological outcomes. ABI-poor sleepers exhibit altered functional connectivity within regions that contribute to motor planning, attention, and self-referential processes, suggesting that disrupted sleep after ABI may impair the integration of sensorimotor and cognitive control systems, and therefore, impair recovery. Full article

Acquired brain injury (ABI) often results in cognitive and motor impairments that can compromise driving ability, an essential aspect of independence and social participation. This study utilized a custom-designed driving simulator to compare driving performance between individuals with ABI and controls, and to examine the relationship between cognitive performance and driving behavior within the control group. All participants completed a series of standardized driving simulation tasks of varying complexity. The control group also completed a neuropsychological battery that assessed attention, processing speed, executive function, and visuospatial abilities. Simulator data were analyzed using generalized linear mixed models to evaluate group differences and, for the control group, cognitive predictors of performance. Results showed that individuals with ABI performed comparably to controls in basic operational tasks but demonstrated reduced performance in cognitively demanding scenarios requiring sustained attention, visuospatial monitoring, and adaptive control, such as rural driving, vehicle following, and parking. In the control group, strong associations were found between simulator outcomes and measures of attention, processing speed, and spatial orientation. The findings support the use of simulator-based assessment as an objective tool sensitive to post-injury impairments and highlight its links to cognitive domains relevant to driving. Full article

Background: Acquired brain injury (ABI) leads to cognitive, emotional, and social impairments that substantially affect quality of life. Although cortical lesions have traditionally received more attention, increasing evidence highlights the importance of the integrity of major white matter association tracts. However, few studies have simultaneously examined cognitive, affective, and social domains within a tractography framework. Methods: In this exploratory pilot study, ten ABI patients underwent diffusion-based tractography of the principal association tracts—the superior and inferior longitudinal fasciculi, the uncinate fasciculus, the inferior fronto-occipital fasciculus, and the cingulum—together with a comprehensive neuropsychological battery covering global cognition, executive functions, memory, emotional symptoms, and empathy. Results: Marked interindividual variability was observed in both tract profiles and neuropsychological outcomes. Findings revealed paradoxical associations, such as larger volumes of the left superior longitudinal fasciculus being linked to poorer cognitive performance, suggesting maladaptive reorganization. Hemispheric lateralization patterns were also identified, with the uncinate fasciculus showing differential contributions to immediate memory and working memory across hemispheres. Notably, empathy scores consistently correlated with volumes of the inferior longitudinal fasciculus, the uncinate fasciculus, and the cingulum, in line with recent evidence on the structural basis of socio-emotional outcomes after ABI. Conclusions: Although limited by sample size, this study provides novel evidence regarding the structure–function paradox, hemispheric specialization, and the clinical relevance of empathy in ABI. Overall, the results support the integration of tractography of the main association tracts with neuropsychological assessment as complementary tools to advance personalized neurorehabilitation. Full article

Background/Objectives: Acquired brain injuries (ABIs), such as stroke, are a major cause of disability globally and frequently affect functional cognition. Functional cognition is the ability to use cognitive processes including memory, attention, and executive functioning to perform daily tasks. When these processes are disrupted, it affects the individual in their participation, independence, and quality of life; it also places a significant burden on family members who often become primary caregivers. The aim of this review is to summarize evidence-based strategies to enhance functional cognition following strokes in an attempt to decrease the caregiver burden and improve both patients and their caregivers’ quality of life. Methods: This review summarizes and interprets findings using an annotated bibliography review and systematic search strategy to gather the most effective and relevant evidence-based interventions for those with ABIs and strokes experiencing memory, attention, and executive dysfunction. Studies outlining adaptive and compensatory interventions were included. Results: Evidence suggests compensatory strategies including environmental and external memory aids, structured routine, technological interventions, metacognitive strategies, as well as attention processing, strategy, and visual imagery training. These tactics demonstrate improvement in functional cognition domains of memory, (particularly prospective memory, i.e., remembering to perform future tasks), attention, and executive functioning after stroke and other ABIs. Conclusions: Effective intervention strategies can help individuals’ post-stroke become more independent in their participation and activities of daily living, leading to decreased caregiver burden and improvements in functional independence and quality of life in both patients and their caregivers. It is suggested that caregivers use these evidence-based approaches in their residential environments. Full article

Impairments of executive function following acquired brain injury including stroke (ABI) contribute significantly to long-lasting everyday difficulties in life. Pilot work on the CO-OP Approach^TM (Cognitive Orientation to daily Occupational Performance Approach), a contextualized strategy training intervention, with ABI adults with executive dysfunction showed improved performance on untrained everyday life tasks and cognitive flexibility. Objective: Our objective was to determine the efficacy of the CO-OP Approach relative to usual occupational therapy (UOT) for community-dwelling adult survivors of ABI with executive dysfunction. Methods: Eighty-seven participants were randomized to receive CO-OP (n = 45) or UOT (n = 42) in their homes. All participants identified five personally meaningful, everyday life goals (using the Canadian Occupational Performance Measure (COPM)) and received up to 15 one-hour treatment sessions twice per week. Three goals were trained, and two were untrained. Interventions were provided by occupational therapists registered with their regulatory college. The CO-OP group was trained to apply a meta-cognitive strategy to three goals. The UOT group received therapy based on the clinicians’ (experienced in community settings) determination. Testers were masked to the participants’ group. Analysis at the primary outcome (Post-test, ~10 weeks following baseline) was on an intent-to-treat basis. Results: Participants in the CO-OP group had a mean age of 57.5 years, a mean time post-ABI of 5.3 years, and were 57.8% men. Those in the usual OT group had a mean age of 54.7 years, a mean time post-ABI of 6.2 years, and were 69.0% men. The CO-OP group reported statistically significant higher improvements on COPM performance and satisfaction scores post-test for untrained and trained goals. However, these benefits were not retained at follow-up (three months post-baseline). Conclusions: The CO-OP Approach^TM shows promise for improving performance in everyday life goals for individuals with chronic ABI relative to usual community occupational therapy. Achieving retention of these benefits remains a challenge. Full article

Background: Acquired brain injury (ABI) often produces heterogeneous cognitive and emotional outcomes that are not fully explained by conventional neuropsychological testing. Diffusion tensor imaging (DTI) tractography may capture patient-specific patterns of white matter connectivity and thereby complement clinical assessment. Methods: We conducted an exploratory case series of nine patients in the subacute phase of ABI (traumatic brain injury or subarachnoid hemorrhage). Each underwent a brief cognitive-emotional battery and 1.5 T DTI with deterministic tractography of major association tracts and the corpus callosum. Tract lateralization was quantified using the Structural Asymmetry Index (SAI), and individual profiles were compared with neuropsychological and emotional data. Results: Six patients met criteria for clinically significant anxiety, and four for depression, often dissociated from global cognitive screening. Tractography revealed heterogeneous asymmetry patterns, most often in the superior longitudinal fasciculus, uncinate fasciculus, and cingulum. In several cases, structural asymmetries diverged from neuropsychological findings, suggesting dissociations between behavioral testing and connectivity-based measures. Conclusions: Within-subject tract asymmetry analysis provided preliminary, potentially clinically relevant information not captured by tests alone. These findings indicate that individualized tractography could enrich the interpretation of cognitive and emotional profiles and help guide hypothesis generation for connectivity-informed neurorehabilitation. Full article

Introduction: Acquired brain injury (ABI) produces significant cognitive, motor, and psychosocial impairments that affect people’s daily functioning. Rehabilitation programs increasingly combine physical activity with neuropsychological strategies for greater effectiveness. Purpose: The aim of this study was to analyze the effects of neurophysiotherapy based on physical activity and neuropsychological rehabilitation on cognitive and psychosocial functioning in individuals with an acquired brain injury (ABI). Method: A total of 19 individuals between the ages of 24 and 89 years (M ± SD: age = 59.26 ± 19.01) belonging to the Acquired Brain Injury Association of Málaga (ADACEMA) participated in this study. A quasi-experimental design with pre- and post-test measures and multiple experimental groups was used. The instruments used were the digit subtest of the Barcelona Test, the Five Digit Test (FDT), the Tower of Hanoi, the modified six-element subtest of the Behavioural Assessment of the Dysexecutive Syndrome, the Trail Making Test (TMT), the WHOQOL-BREF, and the Profile of Mood States (POMS) questionnaire. The Kruskal–Wallis H, Mann–Whitney U, and Wilcoxon tests were used to analyze the data. Results: The results obtained showed a positive effect of physical activity (PA) combined with neuropsychological rehabilitation on working memory, planning, emotional well-being, personal relationships, depressive symptoms, and overall quality of life. Conclusions: The findings suggest that combining neurophysiotherapeutic physical-activity-based rehabilitation with other neuropsychological interventions may be a promising approach to improving executive functioning, emotional well-being, and quality of life in people with an ABI. These preliminary results highlight the potential value of multidisciplinary programs in post-injury recovery, although further studies with larger and more homogeneous samples are needed to confirm these effects. Full article

Robotic devices have become increasingly important in upper-limb rehabilitation, as they assist therapists, improve treatment efficiency, and enable personalised therapy. However, the lack of standardised protocols and integrative tools limits their widespread adoption and effectiveness. To address these challenges, a robotic framework was developed for upper-limb rehabilitation in patients with acquired brain injury (ABI). The framework is designed to be adaptable to various ROS-compatible collaborative robots with admittance control and potentially adaptable to other types of control, and also integrates kinematic and electrophysiological (EMG) metrics to monitor patient performance and progress. It combines data acquisition through EMG and robot motion sensors, gamification elements to enhance engagement, and configurable robot control modes within a unified software platform. A pilot evaluation with eight healthy subjects performing upper limb movements on an ROS-compatible robot from the UR family demonstrated the feasibility of the framework’s components, including robot control, EMG acquisition and synchronization, gamified interaction, and synchronised data collection. User performance through all levels remained below the controller limits of force and velocity thresholds even in the most resistive damping. These results support the potential of the proposed framework as a flexible, extensible, and integrative tool for upper-limb rehabilitation, providing a foundation for future clinical studies and multi-platform implementations. Full article

Background: This study validated the Italian version of the Confusion Assessment Protocol (CAP), a tool designed to assess Post-Traumatic Confusional State (PTCS) in patients with severe acquired brain injury (sABI) who are not evaluable with standard neuropsychological evaluations. Objectives: The primary aim of this study was to promote the CAP as a tool for assessing patients who are not still eligible for standard neuropsychological evaluation and to adapt it to Italian-speaking sABI patients by translating it into Italian and conducting a cross-cultural adaptation and evaluating its psychometric properties. The secondary objective was to correlate the CAP scores with broader functional scales, such as the Levels of Cognitive Functioning Assessment Scale (LCF) and Disability Rating Scale (DRS). Methods: A total of 42 sABI patients were enrolled at IRCCS Fondazione Santa Lucia. The CAP was translated and culturally adapted using international back-translation guidelines. Cross-cultural validity was assessed in 20 patients. The final version was administered by three trained raters over two days to evaluate inter- and intra-rater reliability. Results: The Italian version of the CAP demonstrated high internal consistency and substantial inter-rater reliability for key symptoms, including night-time sleep disturbances, decreased daytime arousal, and psychotic-type symptoms. Cognitive impairment showed moderate inter-rater agreement, likely due to symptom fluctuations typical of this recovery phase. The convergent validity of the CAP was confirmed through its correlations with the Levels of Cognitive Functioning (LCF) and the Disability Rating Scale (DRS), demonstrating its clinical utility in integrating cognitive and behavioral symptom assessments. Conclusions: The Italian version of the CAP is a reliable and valid tool for assessing PTCS in sABI. Future developments should address limitations related to symptom intensity, behavioral domains, and differential symptom weighting. Full article

Objective: This study aims to evaluate the effectiveness of a combined rehabilitative program integrating Graded Motor Imagery (GMI) and Occupational Therapy in improving upper limb function and autonomy in individuals with acquired brain injuries (ABIs), including stroke and traumatic brain injury. Methods: Twelve patients (mean age of 56.4 years) underwent a six-week intervention combining GMI and Occupational Therapy. Outcome measures included the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), Jebsen Taylor Hand Function Test (JTHFT), Canadian Occupational Performance Measure (COPM), 12-Item Short Form Health Survey (SF-12), Numeric Rating Scale for pain (NRS), and Montreal Cognitive Assessment (MoCA). Assessments were conducted at baseline, post-treatment, and at 3- and 6-month follow-ups. Data were analyzed using the Wilcoxon signed-rank test. Results: Statistically significant improvements (p < 0.05) were found in upper limb function (DASH), occupational performance and satisfaction (COPM), and physical health status (SF-12 physical component). Specific gains in hand function—particularly in writing and eating—were detected using the JTHFT. No significant changes were observed in pain perception or mental health outcomes. Conclusions: The integration of GMI with Occupational Therapy appears to be a promising and well-tolerated intervention for enhancing motor function and daily life participation in individuals with ABI. Although the small sample limits generalizability, these preliminary findings support further investigation through larger, controlled studies. Full article

Background/Objectives: There is scarce evidence on the neural underpinnings of balance in people with chronic acquired brain injury (ABI). Thus, the objective was to measure this in adults with ABI during four balance tasks and to examine the relationship between neural activity and balance performance. Methods: Twenty-seven adults with chronic ABI (Age (M ± SD): 51.30 ± 18.67 years, 18 females) were included in this study. Functional near-infrared spectroscopy (fNIRS) was used to measure task-dependent neural activity, which was quantified using oxygenated hemoglobin (HbO) beta values. A force plate was used to measure balance performance, quantified as the amount of sway. One-sample t-tests were used to test for significant task-dependent neural activity during each balance task (HbO > 0) at each fNIRS channel. Pearson’s correlations were used to test for relationships between fNIRS channels with significant task-dependent activity and balance performance. Results: Significant task-dependent neural activity was observed in an fNIRS channel situated over the right superior parietal lobe, p = 0.039, along with 4 channels over the right inferior parietal lobe (IPL), p range = 0.013–0.043 and 3 channels over left IPL, p range = 0.019–0.030. There were moderate negative relationships between IPL activity and balance, r range = −0.441–0.419, p range = 0.031–0.046. Conclusions: We observed significant task-dependent neural activity in superior and inferior parietal lobes. Additionally, greater neural recruitment of the inferior parietal lobes was associated with less sway during balance performance, which provides evidence of the neural underpinnings of balance in ABI. Full article

Background: Upright position recovery (i.e., verticalization) is crucial in the rehabilitation of severe acquired brain injury (sABI). VErticalization by tilt table equipped with robotic-assisted lower limbs cyclic Mobilization (VEM) may facilitate a safer adaptation to vertical posture, reducing orthostatic hypotension occurrence. This multicenter randomized controlled trial (RCT) aims at investigating efficacy, safety, and usability of VEM compared to Traditional Verticalization (TV) using a conventional tilt table in cognitive-motor rehabilitation of sABI patients; Methods: a total of 118 sABI patients with or emerged from prolonged Disorder of Consciousness (pDoC and eDoC) will be enrolled in six post-acute Neurorehabilitation Units and randomly allocated to VEM or TV arm (for each arm: total 25 sessions of 30 min daily treatment/5 days/week/5 weeks). Patients will undergo clinical–functional assessment, resting EEG recording and blood sampling, before, at the end of treatment, and after 1 month; Results: we will expect possible differences in safety and usability of verticalization between VEM and TV rehabilitative intervention and in their efficacy to improve clinical–functional findings and brain indices; Conclusions: this RCT will provide new insights for the intensive, tailored and safe neurorehabilitation intervention in patients with sABI. Full article

Background: The Weekly Calendar Planning Activity (WCPA) is one of the assessments of functional cognition, including executive function, by the cognitive instrumental activities of daily living (C-IADL). It is translated and adapted in many countries, but not in Japan. Methods: This study aimed to examine the validity of the Japanese version of the WCPA-10 (WCPA-10-J) in patients with acquired brain injury (ABI), and to explore the characteristics of cognitive strategy use among that population. Fifty-three patients with ABI aged 27–81 years and 52 healthy controls (HCs) completed the WCPA-10-J, three neuropsychological tests, and the assessment of the instrumental activities of daily living (IADL). Results: Results demonstrated that the WCPA-10-J was able to discriminate between the patients with ABI and the HCs. We found significant limitations in ABI patients’ ability to use strategies. Concurrent, convergent, and ecological validities were partly demonstrated through correlations between the neuropsychological test scores, IADL, and the WCPA-10-J performance. Conclusions: This study provides initial evidence for the validity of the WCPA-10-J for patients with ABI and suggests the need to use performance-based tests even in patients with normal cognitive screening test results. The WCPA-10-J could provide useful information for strategy-based interventions for patients with ABI. Full article