Maria Grazia Maggio

Background/Objectives: Multiple sclerosis (MS) affects motor, cognitive, psychological, and social functioning that impairment-based scales do not fully capture. This systematic review evaluated the measurement properties and applications of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in adults with MS across research and clinical contexts. Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to 25 May 2026. Eligible peer-reviewed studies reported extractable WHODAS data in adults with MS. Evidence was organized into measurement, clinical-association, participation/employment, intervention, digital-monitoring, and longitudinal streams. Design-appropriate critical-appraisal tools and outcome-specific certainty assessments were applied; quantitative pooling was assessed but was not justified. Results: Of the 677 records identified, 28 reports were included. Five reports evaluated measurement properties; moderate-certainty evidence supported reliability and construct validity, although precision differed among 12-, 32-, and 36-item forms. Associations with quality of life and clinical severity were supported by low-certainty evidence. Evidence concerning fatigue, mood, cognition, participation, and employment was of low or very low certainty because most studies were cross-sectional, used heterogeneous metrics, or involved overlapping cohorts. Intervention evidence was of very low to low certainty: WHODAS was secondary, and interventions, time points, and scoring methods were not comparable. Eight reports arose from one overlapping research program. Conclusions: WHODAS 2.0 provides a multidimensional patient-reported account of functioning in MS and may complement, but not replace, the Expanded Disability Status Scale. Evidence supports measurement use more strongly than prognostic, treatment-response, or benefit-determination claims. Standardized version selection, scoring, domain reporting, and prespecified longitudinal endpoints are required.

Objectives: This systematic review examined studies combining transcranial direct current stimulation (tDCS) with virtual reality (VR) in healthy or non-clinical populations. The aim was to evaluate whether active tDCS provides additional benefits when delivered during VR-based tasks or interventions aimed at improving behavioral abilities. Methods: Following PRISMA guidelines, a comprehensive search of electronic databases (2000–September 2025) identified randomized and non-randomized studies employing simultaneous tDCS and VR in healthy individuals. Studies reporting psychological or cognitive quantitative outcomes were included. Risk of bias was assessed using RoB-2 and ROBINS-I tools. Results: Twelve studies met inclusion criteria. The included studies were highly heterogeneous in terms of sample size, VR systems, stimulation parameters, targeted cortical regions, outcome measures, and control conditions. Most designs compared active tDCS during VR with sham tDCS during the same VR exposure. Therefore, the available evidence mainly addresses whether tDCS adds value to VR-based procedures, rather than whether tDCS and VR exert independent or synergistic effects. Some studies reported favorable between-group effects on emotional control or skill acquisition. However, in other cognitive domains both active and sham/control VR groups improved, suggesting that VR training or exposure itself may have contributed substantially to the observed changes. Moreover, small sample sizes, multiple outcome testing, and limited correction for multiple comparisons reduce confidence in borderline findings. Conclusions: Current evidence suggests that active tDCS may incrementally enhance selected VR-based outcomes in healthy populations, particularly in emotional control and skill-learning domains. However, the literature does not yet support strong claims of synergistic interaction between tDCS and VR. Future studies should use adequately powered factorial designs including VR-only, tDCS-only, combined, and sham/no-intervention conditions to disentangle independent, additive, and interaction effects.

Background: Caregiver burden represents a multidimensional syndrome influenced by patient-related, relational, and contextual factors in neurological disorders. Although stroke, Parkinson’s disease (PD), and Alzheimer’s disease (AD) differ in clinical trajectory, comparative analyses of caregiver risk profiles across these conditions remain limited. Objective: This study aimed to identify sociodemographic, cognitive, and dyadic factors associated with caregiver burden in a clinical cohort, and to investigate their value for caregiver risk stratification using supervised machine learning models. Methods: In this monocentric observational cohort study, 113 patient–caregiver dyads (79 stroke, 19 PD, 15 AD) were consecutively enrolled in a neurorehabilitation setting. Patients underwent cognitive assessment with the Montreal Cognitive Assessment (MoCA), while caregivers completed the Caregiver Burden Inventory (CBI), which was considered the primary outcome measure. Caregiver burden was dichotomized into mild versus moderate-to-severe burden using established CBI cutoff thresholds. Group comparisons, correlation analyses (false discovery rate–corrected), and supervised machine learning models (logistic regression, random forest, AdaBoost, support-vector machine, naïve Bayes, and CatBoost) were performed using 5-fold stratified cross-validation repeated 10 times. Results: Disease-specific burden patterns emerged. Stroke caregivers reported higher time-dependent burden, whereas AD caregivers showed greater emotional burden (p < 0.05). No significant differences were observed in total CBI scores across groups. Lower MoCA scores were moderately associated with higher total and time-dependent burden (r up to −0.49, p < 0.001), particularly when interacting with advanced patient age. Machine learning models showed moderate performance, with AdaBoost achieving the highest accuracy (75.8%) and logistic regression and CatBoost the highest area under the receiver-operating-characteristic curve (AUC = 0.80). The most influential predictors were the age × MoCA interaction, MoCA score alone, and patient–caregiver gender concordance. Cognitive impairment, especially in older patients, and dyadic gender concordance emerged as central risk factors. Conclusions: Multidimensional assessment and early risk stratification, potentially supported by machine learning tools, may improve identification of vulnerable caregivers and guide tailored interventions.

Background/Objectives: Sexual health is frequently under-addressed after stroke, despite its relevance to intimacy, identity, relationships, and rehabilitation. This convergent mixed-methods study integrated sex-specific screening with descriptive narrative material to examine sexual functioning and patient-reported concerns in clinical rehabilitation. Methods: Twenty-six adults were assessed: ten with the Female Sexual Function Index (FSFI), sixteen with an International Index of Erectile Function six-item field (IIEF-6), and ten with analyzable semi-structured interview responses. The sex-specific measures were analyzed separately. Continuous variables were summarized by median and interquartile range; nonparametric correlations and group comparisons underwent Benjamini–Hochberg false discovery rate correction. Quantitative and qualitative findings were integrated in a participant-level joint display. This integration yielded case-level meta-inferences rather than inferential mixed-methods testing in this sample. Results: Nine of ten FSFI profiles and nine of sixteen IIEF-6 profiles met the respective exploratory threshold for possible dysfunction. No association or group comparison remained statistically significant after correction. Six of eighteen threshold-positive profiles had analyzable interviews, twelve represented narrative silence, and four interviewed participants were threshold-negative. Narratives documented fear, embarrassment, reduced desire or sexual frequency, relational or communication change, support needs, clinical sequelae, and positive or neutral adaptation. Screening and narratives showed convergence, complementarity, and divergence: low scores did not establish personal distress, whereas concerns could occur above a threshold. Conclusions: Responsive sexual rehabilitation should combine confidential, permission-based, patient-led screening and narrative inquiry with individualized information, optional support, appropriate referral, and reassessment according to readiness. These preliminary, hypothesis-generating findings do not validate an intervention or support confirmatory inference.

Background: Workplace victimization is a form of repeated and systematic psychological violence that can severely affect both mental and physical health. From a psychological perspective, it impacts mood states, defense mechanisms, and personality functioning. Methods: This cross-sectional study investigated the psychological and behavioural correlates of workplace victimization in a sample of 33 workers from various professional sectors, using a multidimensional assessment including standardized measures of personality traits, mood states, and defense mechanisms. Results: The MMPI-2 profile revealed elevated scores in Hypochondriasis (Hs: 72.00), Depression (D: 70.21), Hysteria (Hy: 67.61), and Paranoia (Pa: 68.76), indicating somatic symptoms, depressive features, and suspiciousness. The POMS showed increased Tension–Anxiety (T: 65.06), Depression–Dejection (D: 68.21), Anger–Hostility (A: 68.15), and Fatigue–Inertia (F: 65.24), alongside reduced Vigor–Activity (V: 43.18). The DMI analysis highlighted a high Reversal score (REV: 65.91), suggesting a predominant use of defense mechanisms such as altruism and idealization to cope with distress. Conclusions: In this selected sample of adults referred for psychological evaluation for suspected or documented workplace victimization, participants showed a clinically relevant psychological burden, including depressive symptoms, somatic concerns, Anger–Hostility, fatigue, reduced vigor, and specific defensive patterns. Given the cross-sectional design, small sample size, and absence of a control group, these findings should be interpreted as preliminary and cannot establish causality or the specificity of this profile to workplace victimization.

Objective: This systematic review aimed to examine how sex differences and, when available, gender-related factors affect rehabilitation outcomes in individuals with TBI. Design: Systematic review registered in PROSPERO (ID: 1018531) and conducted in accordance with PRISMA guidelines and the Cochrane Handbook. We included randomized controlled trials and observational and experimental studies published in the past 5 years (2020–2025) that explicitly analyzed sex- and/or gender-related differences in response to a rehabilitation intervention after TBI. Interventions: Various rehabilitation programs, including conventional therapy, virtual reality, and telerehabilitation. Main measures: Cognitive, motor, emotional, functional, and social outcomes, analyzed by biological sex and, when available, gender-related psychosocial traits. Results: Six studies met the inclusion criteria. Most findings referred to sex-based differences: female participants (sex: female) demonstrated better recovery in cognitive and social functioning, potentially linked to neuroprotective effects of estrogen and progesterone. However, they also reported higher anxiety and more persistent postconcussive symptoms. Only one study investigated gender as a social construct, suggesting that gender-related social traits, particularly those culturally associated with femininity, were associated with reduced access to rehabilitation services. A subset of studies evaluated technology-assisted interventions (e.g., virtual reality, telerehabilitation); however, sex/gender-differential effects were rarely tested, limiting firm conclusions about tailoring by sex or gender. Conclusions: Although current evidence predominantly concerns sex-based differences, limited data also point to a potential role of gender-related social factors. Together, these findings suggest that sex and gender may significantly shape rehabilitation outcomes after TBI. Integrating sex- and gender-sensitive strategies into clinical pathways may improve equity, enhance personalization, and optimize recovery. Standardized, gender-inclusive protocols are needed to address disparities and promote fair access to neurorehabilitation.

Constraint-Induced Movement Therapy in Children With Hemiplegic Cerebral Palsy: A Scoping Review of Functional Outcomes and Neuroplasticity-Related Evidence

Background: Computerized cognitive training (CCT) is increasingly used in pediatric rehabilitation; however, its application across developmental disorders remains heterogeneous in terms of targets, delivery models, and outcomes. This scoping review aimed to map the currently available CCT tools used in children with developmental disorders and to summarize their main characteristics, clinical targets, and evidence gaps. Methods: We conducted a scoping review in accordance with the PRISMA-ScR framework and registered the protocol on the Open Science Framework (OSF; DOI 10.17605/OSF.IO/9XQ5H). We searched peer-reviewed studies investigating CCT in children with developmental disorders and extracted data on device characteristics, target domains, training modalities, study design, and main findings. Results: Twenty-two studies describing 21 devices were included. Evidence was heterogeneous across diagnoses, intervention architectures, comparators, and outcome measures. The most consistent signal emerged in ADHD, where some programs reported improvements in working memory and selected executive-function outcomes. Evidence in learning-related and intellectual developmental conditions was more variable and device-specific, while the only ASD study identified did not show superiority over mock training. Discussion: CCT appears clinically attractive because of its adaptability, gamified delivery, and potential for home-based use; however, the current evidence base is uneven and does not support broad efficacy claims across developmental disorders. More disorder-specific studies with stronger comparators and ecologically valid outcomes are needed. Systematic Review Registration: https://osf.io/9xq5h , doi: 10.17605/OSF.IO/9XQ5H.

Acquired brain injury (ABI) refers to damage to the brain occurring after birth and includes both traumatic brain injury (TBI), resulting from external mechanical forces, and non-traumatic aetiolog...

Objective: The digital transformation of psychological assessment workflowshas become increasingly important to enhance efficiency, data quality, and secure data management in clinical and research contexts. This study aimed to develop and technically evaluate a low-code, platform-indipendent framework that enable secure digita psychological data collection, automated scoring, standardized data management, and scalable deployment across clinical and research settings without requiring dedicated software development. Methods: Dedicated online form collections and project-specific cloud-storage folders were created for each research project. Spreadsheet files exported from the forms included automated scoring sheets and a simplified, password-protected SCORING VIEW. Data were pseudonymized and stored in the institutional digital environment, supporting secure data management through institutional acces-controll mechanism. The framework was evaluated across 22 research projects involving 10,214 assessments and 90 standardized instruments. Automated and manual scoring were compared using agreement analyses and processing-time evaluations. Results: The framework demonstrated high agreement between automated and manual scoring procedures, with near-perfect agreement for the evaluated instruments. Automated scoring substantially reduced processing time compared with manual procedures (p < 0.0001). The system also supported standardized data organization, controlled access management, and consistent dataset generation during routine implementation. Conclusions: The proposed frameworks provides a fast, reliable, and secure solution for digital psychological data collection, automated scoring and standardized data management supporting scalable, reproducible, and multi-center research. Its architecture facilitates multi-user collaboration offering a replicable model for multicenter and longitudinal studies.