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Objective The aim of this study was to determine the effectiveness of a novel body-weight-supported (BWS) gait training system with visual feedback, called Copernicus® (Rehalife, Italy). This computerized device provides comfortable, regular and repeatable locomotion in hemiplegic patients. Through visual real-time monitoring of gait parameters, patients are trained to transfer weight loading alternately on both feet. Design A single-blind, randomized controlled study. A single center used a computer-generated randomization code to allocate treatments. Setting Intensive rehabilitation unit (IRU) at the Institute S. Anna (Italy). Participants 63 first-ever stroke patients (39 men, age: 66.1 ± 9.6 years; 61.6 % with left-sided lesion) randomly distributed into three demographically/clinically matched groups. Treatments All groups were treated five times a week for 2 -h sessions for six consecutive weeks. The first group (“control”) underwent a conventional physical therapy; the second group performed advanced BWS gait training sessions without visual feedback (Experimental VF- group); whereas the third group used BWS with visual feedback stimulation (Experimental VF+ group). Main Outcome Measures Absolute changes were recorded using conventional clinical scales and kinematic measurement of static gait balance from baseline to follow-up. Results Significant interaction Group*Time effects scales (F2,126 = 5.1, p-level = 0.005, η²p = 0.25; F2,126 = 4.7, p-level = 0.007, η²p = 0.19; respectively) were detected in the Functional Independence Measure and Tinetti-Balance scales. Post hoc analysis demonstrated that the recovery of motor functioning was greater for the VF + group with respect to other groups (all p’s ≤ 0.001). A similar pattern of findings was also obtained with a stabilometric analysis, demonstrating a better clinical improvement in static balance after VF + treatment. Conclusion The proposed advanced rehabilitation system with visual feedback was more effective in improving gait recovery with respect to conventional and high-tech therapies without a sensor feedback.

The kinematic analysis of trunk recovery in patients with stroke has sparsely been investigated. This study is aimed at evaluating the validity of a kinematic system for measuring trunk movements. Forty-five right-handed stroke patients in the post-acute phase were assessed in a within-subject design, before and after intensive conventional neurorehabilitation treatment. An eight-camera system was used to analyze the three-dimensional (3D) kinematics of trunk during typical displacements (anterior/posterior and right/left lateral). Kinematic trunk measurements and clinical evaluations were performed immediately in a blind fashion before and after rehabilitation treatments. Of the 9 kinematic variables, 4 showed a significant relationship with the clinical measure of the trunk: Trunk Control Test (TCT). Among these, only the kinematic evaluation of the lateral pelvic was the best predictor (R2= 0.2; p-level< 0.006; beta= 0.41) of clinical recovery measured with TCT. Here, we present a 3D kinematic system for assessing trunk impairments in stroke patients. We found that different kinematic variables reflect motor recovery as assessed by conventional clinical scale. Further evaluations, including reliability analysis and application on patients with gait impairments, are required.

The neurorehabilitation of cerebellar damage in neurological patients (i.e., stroke or multiple sclerosis) remains sparsely studied. This case report is aimed at providing evidence on the development of a new cognitive approach targeting cerebellar functions. We hope that our paper will stimulate an interesting scientific debate (http://neurosciencenews.com/chef-neurobiology-6196/), which comes from our previous study demonstrating the tight relationship between cooking activity and the cerebellar functioning: (https://doi.org/10.1371/journal.pone.0171457; https://doi.org/10.1016/j.jns.2018.01.037).

Background and importance The therapeutic approach for cerebellar damages heavily relies on neurorehabilitation since there are no medications that may improve clinical symptoms mainly those related to cognitive dysfunctions. Nevertheless, neurorehabilitation programs tailored to cerebellar damages have never been validated. Here we describe a new rehabilitation approach based on cooking training (CT). The idea that cooking may stimulate cerebellar activity relies on previous evidence demonstrating the beneficial effect on the executive functions as well as in promoting neural plasticity within the cerebellum. Indeed, CT requires motor/mental coordination, thinking flexibly, planning, implementing strategies, shifting and self-monitoring behaviors, all functions drastically affected in cerebellar disorders. Case description A 68-year-old male stroke patient with isolated right cerebellar ischemia in the posterior cerebellum characterized by mild executive dysfunctions. After intensive six weekly two-hour sessions, we found that CT was effective in improving some cognitive abilities in a context of mild motor impairment. In particular, deficits in the execution of the Symbol digit modality test and Wisconsin card-sorting test were recovered. Conclusion The comparison of our data with those reported in previous studies confirmed the Schmahmann’s hypothesis on the effectiveness of neurorehabilitation approaches in cerebellar patients acting as external timekeeping of conscious thoughts.

In recent years, as part of the rehabilitation of post stroke patients, the use of robotic technologies to improve recovery of upper limb has become more widespread. The Automatic Recovery Arm Motility Integrated System (ARAMIS) is a concept robot and prototype designed to promote the functional interaction of the arms in the neurorehabilitation of the paretic upper limb. Two computer-controlled, symmetric and interacting exoskeletons compensate for the inadequate strength and accuracy of the paretic arm and the effect of gravity during rehabilitation. Rehabilitation is possible in 3 different modalities; asynchronous, synchronous and active-assisted.To compare the effectiveness of robotic rehabilitation by an exoskeleton prototype system with traditional rehabilitation in motor and functional recovery of the upper limb after stroke.Case-control study, 52 patients enrolled in the study, 28 cases (women: 8, age: 65 ± 10 yrs) treated with ARAMIS and 24 controls (women: 11, age: 69 ± 7 yrs) with conventional rehabilitation. Motor impairment assessed before and after treatment with Fugl-Meyer scale and Motricity Index, level of disability assessed with the Functional Independence Measure. A questionnaire was also administered to assess the patient's tolerance to robotic therapy.After 28 ± 4 sessions over a 54 ± 3.6-day period, the patients treated by ARAMIS had an improvement on the Fugl-Meyer scale (global score from 43 ± 18 to 73 ± 29; p0.00001), Motricity Index scale (p0.004) and Functional Independence Measure (p0.001). A lesser degree of improvement was achieved using conventional rehabilitation, the Fugl-Meyer global score of the control group improved from 41 ± 13 to 58 ± 16 (p0.006) and the motor function item from 9.4 ± 4.1 to 14.9 ± 5.8 (p0.023).Motor improvement was greater at the wrist and hand than at shoulder and elbow level in patients treated by ARAMIS and controls, but it was significantly greater in ARAMIS-treated patients than in controls. The results indicate a greater efficacy of ARAMIS compared to conventional rehabilitation.

Frequency-domain techniques describe oscillations as a fundamental behavior of neurons and brain signals. Oscillations synchronize over large portions of cortex and mediate in the spatiotemporally coherent activation of neuron assemblies required for brain processing to occur. Oscillations in the gamma band (~20.0–80.0 Hz) originate from the tonic excitation of inhibitory interneuron networks, sustain rhythms and frequency constancy, and are enhanced during sensory, motor, or “cognitive” processes through frequency-dependent and function-related neuronal synchronization. Experimental work indicates a role of gamma activity in conscious perception. Further investigation is, nevertheless, warranted as gamma-band synchronization plays a functional role in low-level phase coding as well as in high-complexity neural processes related to perception, such as selective attention, focused arousal, multistable or ambiguous perceptive conditions, visuomotor integration, and associative learning.

Background The association between malnutrition and worse outcomes as pressure ulcers and mortality is well established in a variety of setting. Currently none investigation was conducted in patients with long-term consequences of the acquired brain injury in which recovery from brain injury could be influenced by secondary complications. The aim of this study was to investigate the association between various nutritional status parameters (in particular albumin) and pressure ulcers formation and short-term mortality in minimal conscious state patients. Methods In this prospective, observational study of 5-months duration, a 30 patients sample admitted to a Neurological Institute was considered. All patients underwent a complete medical examination. Anthropometric parameters like mid-arm circumference and mid-arm muscle circumference and nutritional parameters as serum albumin and blood hemoglobin concentration were assessed. Results At univariate and logistic regression analysis, mid-arm circumference (p = 0.04; beta = −0.89), mid-arm muscle circumference (p = 0.050; beta = −1.29), hemoglobin (p = 0.04, beta −1.1) and albumin (p = 0.04, beta −7.91) were inversely associated with pressure ulcers. The area under the ROC curve for albumin to predict sores was 0.76 (p = 0.02) and mortality was 0.83 (p = 0.03). Patient with lower albumin had significantly higher short-term mortality than those with higher serum albumin (p = 0.03; χ2 test = 6.47). Conclusion Albumin, haemoglobin and mid-arm circumference are inversely associated with pressure ulcers. Albumin is a prognostic index in MCS patients. Since albumin and haemoglobin could be affected by a variety of factors, this association suggests to optimize nutrition and investigate on other mechanism leading to mortality and pressure ulcers.