1,721,047 research outputs found
Assessing pain in patients with chronic disorders of consciousness: Are we heading in the right direction?
No full textThe deterioration of sensory-motor integration within the pain matrix in patients with chronic Disorders of Consciousness (DoC) is one of the principal mechanisms responsible for non-conscious pain perception. The present study aimed to assess whether the variability in the inter-peak interval (IPI) between the N2 and P2 components of laser evoked potentials (LEP) could represent an objective marker of the behavioral responsiveness to nociceptive stimulation, as measured by the Nociception Coma Scale-Revised (NCS-R), and regardless of the sensory part of pain processing. We found that only IPI variability showed a significant correlation with NCS-R score, independently of the stimulation intensity (that influences the sensory part of pain processing). It was thus concluded that IPI variability might represent an objective measure of pain processing, which may help clinicians in the development of effective pain management strategies
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Shedding new light on disorders of consciousness diagnosis: The dynamic functional connectivity
No full textIt has been proposed that awareness may depend on the highly-dynamic functional connectivity of large-scale cortico-thalamo-cortical networks. We investigated how brain connectivity changes over time in the resting state in a group of patients with chronic disorders of consciousness (DoC). To this end, we assessed dynamic functional connectivity (DFC) in the resting state by analyzing the time-dependent EEG phase synchronization in five frequency bands (δ θ α β and γ). Patients in Minimally Conscious State (MCS) showed changes in DFC matrices and topography over time (mainly in the γ range), which were significantly different from those observed in patients with Unresponsive Wakefulness Syndrome (UWS). The degree of DFC significantly correlated with the level of behavioral responsiveness measured using the Coma Recovery Scale-Revised. The analysis of DFC seems promising to differentiate patients with DoC. Moreover, sharpening the current knowledge of DFC by using EEG-based approaches may shed light on the processes of consciousness and their pathophysiology, and may help to design neuromodulation protocols aimed at targeting maladaptive and dysfunctional FC
Do you see me? The role of visual fixation in chronic disorders of consciousness differential diagnosis
No full textVisual fixation (VF) of a target is a possible, although atypical, feature of the Unresponsive Wakefulness Syndrome (UWS). Whether VF may indicate residual awareness in these patients is debatable, since it may simply subtend a series of reflex processes. Objective tools should therefore be used to identify aware VF, which depends on the integrity of visuomotor networks encompassing frontal-parietal-occipital areas. The aim of our study was to detect residual visuomotor network functionality potentially sustaining aware VF. To this end, we evaluated the visuomotor integration (VMI) and visual P300 patterns in a chronic Disorder of Consciousness (DOC) sample and a control group of healthy individuals (HC), using an associative stimulation protocol combining transcranial magnetic stimulation (TMS) with visual stimulation through transorbital alternating current stimulation. The Minimally Conscious State (MCS) patients showed preserved patterns of VMI and P300, whereas nearly all the UWS patients showed no significant VMI. Notably, the electrophysiological findings were correlated with the visual domain of the Coma Recovery Scale-Revised. Nonetheless, two fixating UWS individuals had a VMI similar to MCS patients. Our data suggest that some UWS patients showing VF could be aware, but unable to manifest it clearly, probably because of a severe motor output impairment, which is a condition compatible with the Functional Locked-In Syndrome
How far can we go in chronic disorders of consciousness differential diagnosis? The use of neuromodulation in detecting internal and external awareness
No full textAwareness generation and modulation may depend on a balanced information integration and differentiation across default mode network (DMN) and external awareness networks (EAN). Neuromodulation approaches, capable of shaping information processing, may highlight residual network activities supporting awareness, which are not detectable through active paradigms, thus allowing to differentiate chronic disorders of consciousness (DoC). We studied aftereffects of repetitive transcranial magnetic stimulation (rTMS) by applying graph theory within canonical frequency bands to compare the markers of these networks in the electroencephalographic data from 20 patients with DoC. We found that patients’ high-frequency networks suffered from a large-scale connectivity breakdown, paralleled by a local hyperconnectivity, whereas low-frequency networks showed a preserved but dysfunctional large-scale connectivity. There was a correlation between metrics and the behavioral awareness. Interestingly, two persons with UWS showed a residual rTMS-induced modulation of the functional correlations between the DMN and the EAN, as observed in patients with MCS. Hence, we may hypothesize that the patients with UWS who demonstrate evidence of residual DMN–EAN functional correlation may be misdiagnosed, given that such residual network correlations could support covert consciousness
Functional connectivity in multiple sclerosis after robotic rehabilitative treatment: A case report
No full textRATIONALE: Multiple sclerosis (MS) is an inflammatory demyelinating disease of central nervous system and it is associated with an impaired motor function status. The efficacy of rehabilitation in promoting functional recovery and increasing quality of life in MS patients has been demonstrated. PATIENT CONCERNS: A 47-year-old woman was diagnosed with relapsing-remitting multiple sclerosis (RRMS) in November 2014 because of left upper limb hypoesthesia and weakness with difficulty in hand manipulation skills (there was a 1-point Expanded Disability Status Scale (EDSS) progression, i.e., 2.5 vs 1.5). Magnetic resonance image (MRI) showed a new frontal right cortical high-signal-intensity lesion. DIAGNOSIS: Neurological and MRI examination were suggestive of MS diagnosis. INTERVENTIONS: Patient was treated with robotic rehabilitation and evaluated by a Glove Analyzer for fMRI system (GAF). Functional MRI (fMRI) was acquired before and at the end of rehabilitative treatment performed with robotic device (Armeo-power). OUTCOMES: At the end of the rehabilitation program, most of the behavioral parameters, GAF and fMRI evaluation, showed a significative improvement. Moreover, fMRI showed a significantly increased functional activation within the sensory-motor network in the active, motor task. LESSONS: Our findings suggest a possible restorative effect of robotics on brain networks. Moreover, we may argue that GAF may be a valuable tool in assessing functional recovery after upper limb rehabilitation, especially of associated to fMRI examination
What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and meta-analysis
No full textBackground Studies about electromechanical-assisted devices proved the validity and effectiveness of these tools in gait rehabilitation, especially if used in association with conventional physiotherapy in stroke patients. Objective The aim of this study was to compare the effects of different robotic devices in improving post-stroke gait abnormalities. Methods A computerized literature research of articles was conducted in the databases MEDLINE, PEDro, COCHRANE, besides a search for the same items in the Library System of the University of Parma (Italy). We selected 13 randomized controlled trials, and the results were divided into sub-acute stroke patients and chronic stroke patients. We selected studies including at least one of the following test: 10-Meter Walking Test, 6-Minute Walk Test, Timed-Up-and-Go, 5-Meter Walk Test, and Functional Ambulation Categories. Results Stroke patients who received physiotherapy treatment in combination with robotic devices, such as Lokomat or Gait Trainer, were more likely to reach better results, compared to patients who receive conventional gait training alone. Moreover, electromechanical-assisted gait training in association with Functional Electrical Stimulations produced more benefits than the only robotic treatment (−0.80 [−1.14; −0.46], p >.05). Conclusions The evaluation of the results confirm that the use of robotics can positively affect the outcome of a gait rehabilitation in patients with stroke. The effects of different devices seems to be similar on the most commonly outcome evaluated by this review
Tele-health services for the elderly: A novel southern Italy family needs-oriented model
No full textIntroduction: The world population is aging. By 2050, the global population aged over 65 years will have doubled, leading to big societal challenges for ensuring healthy, independent, and productive lives for older people. Thus, innovative local and national initiatives for e-health services are growing in an attempt to overcome such problems. Methods: We examined the effects of a telehealth system, i.e. tele-monitoring of vital parameters and neurological/psychological tele-counseling, within a family-centred service provided by a local day centre. We evaluated the clinical and neurobehavioral symptoms of 18 elderly patients (aged 65 years and over) and the care burden of their 20 caregivers, besides the usability of the tool. Results: The one-way repeated analysis revealed a significant worsening in daily living activities (p < 0.01 and p = 0.02, respectively for Activities of Daily Living (ADL) and Independent IADL (IADL)) versus a significant improvement of the patients' psychiatric condition (p < 0.001), besides a significant gradual reduction of the caregivers burden (p < 0.001). Health status perception increased through time (from an average score of 5.67 ± 1.08 at baseline to 7.72 ± 1.32 at the end of the study). Discussion: It appears that a telehealth system integrated in a local health care service may significantly improve elderly persons’ behaviour, and also reduce the caregivers’ burden
- …
