Pasquale Moretta

Background: technology can significantly improve quality of life for individuals with motor and cognitive disabilities, especially during the transition from rehabilitation to home. However, the success of assistive solutions depends on understanding patients’ functional status, needs, and attitudes toward technology. Methods: we investigated these factors using a multimodal assessment protocol, including the USASS questionnaire and ADL/IADL scales, among 69 participants admitted to intensive neuromotor rehabilitation, most of whom had caregivers (83.6%). Participants were grouped into three sample-derived ordinal categories (Low, Medium, High) based on ADL/IADL scores and age. Results: functional autonomy strongly predicts technology adoption and perceived benefits, surpassing age as a determinant. Individuals in the group with higher sample-derived functional levels reported greater independence in technology use and higher Quality Tech Impact scores. Correlation analysis confirmed moderate-to-strong positive associations between ADL/IADL scores and Quality of Life Index, with the strongest association observed for IADL (ρ = 0.703, 95% CI: 0.559–0.806, p < 0.001). These findings suggest that interventions should prioritise improving functional skills rather than focusing solely on age-related factors to enhance technology adoption and its positive impact. A proactive attitude toward technology is essential to avoid ineffective investments in assistive solutions. Ultimately, functional autonomy emerges as an important contributor of both technological engagement and overall well-being.

Stroke remains one of the leading causes of adult disability worldwide, with cognitive impairment representing one of its most devastating and persistent consequences

Background: Aphasia, a common consequence of left-hemisphere stroke, significantly impairs communication and daily functioning. Various studies have explored language recovery but only few have focused on the predictors of recovery of functional communication in patients with stroke. Objective: To identify clinical and linguistic factors associated with functional communication outcomes in patients with post-stroke aphasia. Methods: We enrolled 61 patients with aphasia due to left-hemispheric stroke, admitted to post-acute neurorehabilitation centers. Patients underwent neuropsychological, functional, and language assessments at admission (T0) and discharge (T1). Language abilities were evaluated with the Brief Exam of Language—II (BEL-II), and functional communication was measured through caregiver-rated I-CETI scores. Depression, basic (ADL) and instrumental (IADL) activities of daily living were also assessed. Correlations and regression models were used to examine predictors of functional communication recovery (ΔCETI). Results: Significant improvements were observed in all language domains, functional independence, and mood symptoms from T0 to T1 (p < 0.003). Regression analysis showed that demographic and general clinical variables (e.g., age, etiology, dysphagia) were not significant predictors of ΔCETI. However, ADL score, comprehension skills (Token test and comprehension sub-score of BEL-II) were significantly associated with functional communication recovery (β = 0.51, β = 0.68 and β = 0.75, respectively; p < 0.05). Conclusions: Functional communication recovery in post-stroke aphasia is strongly associated with initial comprehension abilities and functional autonomy in basic life activities, rather than demographic or general clinical variables. These findings highlight the need for targeted interventions aimed at improving receptive language and the importance of including ecologically valid communication assessments in post-stroke rehabilitation protocols.

Background: Amyotrophic lateral sclerosis (ALS) is a multisystem neurodegenerative disease encompassing cognitive and behavioral impairments. The Revised Diagnostic Criteria for ALS‐frontotemporal spectrum disorder (ALS‐FTDS), while widely adopted, may overlook subtle impairments such as memory and visuospatial deficits, limiting their prognostic value.Objectives: This study aimed to apply the Mild Behavioral and Neurocognitive Impairment (MBNI) approach, adapted from other neurodegenerative diseases, to ALS patients and assess its prognostic utility for survival and disease progression.Methods: A prospective cohort of 201 ALS patients was evaluated between January 2018 and July 2024. Participants underwent comprehensive cognitive and behavioral assessments. The MBNI approach identified patients with mild cognitive impairment (MCI), mild behavioral impairment (MBI), or combined cognitive‐behavioral impairment (MCBI). Prognostic value was analyzed using Kaplan–Meier survival curves, Cox proportional hazards models, and logistic regression for disease progression.Results: Mild cognitive and/or behavioral impairments were detected in 67% of patients classified as cognitively normal by ALS‐FTDS criteria. At a median follow‐up of 15 months, these patients showed shorter tracheostomy‐free survival (all p < 0.005). MCI (HR5.3; CI 1.10–25.41; p = 0.038) and frontotemporal dementia (HR6.2; Confidence Interval: 1.34–28.40; p = 0.019) independently predicted poor outcomes. Logistic regression confirmed that MCBI and frontotemporal dementia were associated with rapid progression (both p < 0.019).Conclusion: The MBNI approach enhances the detection of mild cognitive and behavioral impairments in ALS, providing prognostic insights and improving stratification over the Revised Diagnostic Criteria for ALS‐FTDS. This framework supports personalized care and the design of clinical trials targeting early disease stages.

Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease characterized by chronic airflow limitation and persistent respiratory symptoms. It is a major cause of morbidity and mortality worldwide, significantly impacting healthcare systems with considerable socioeconomic consequences. The main risk factors include exposure to tobacco smoke, environmental pollutants, occupational dust, and genetic factors such as alpha-1 antitrypsin deficiency. COPD is often associated with extrapulmonary comorbidities, particularly psychiatric disorders like depression and anxiety, which worsen patients’ quality of life and prognosis. The prevalence of these disorders in patients with COPD varies significantly but is always higher than in healthy controls. Psychiatric disorders can negatively influence COPD management and vice versa, creating a complex bidirectional interaction. Depression and anxiety are the most common psychiatric comorbidities in patients with COPD, influenced by factors such as social isolation, physical limitations, and fear of exacerbations. Diagnosis of these psychiatric disorders is complicated by the overlap of symptoms with those of COPD. However, some screening tools can facilitate early detection. The treatment of psychiatric disorders in patients with COPD in a rehabilitation setting requires a multidisciplinary approach involving pulmonologists, neurologists and psychologists. Pharmacological therapy with antidepressants shows mixed results in terms of efficacy and safety, with some studies reporting benefits on quality of life and others suggesting an increased risk of exacerbations and pneumonia. An integrated approach that includes the assessment and intervention of mental disorders is essential to improve the overall management of COPD and the quality of life of patients. This narrative review provides an overview of the main psychiatric comorbidities in COPD patients, aiming to fill gaps in the literature and suggest areas for future research.

Background: Neurofibromatosis type 1 (NF1) is a genetic disorder that affects multiple systems in the body, often leading to physical disfigurements and a wide range of clinical symptoms. This study aims to investigate the relationship between NF1 severity and visibility and the quality of life (QoL) in children. Methods: The Pediatric Quality of Life Inventory (PedsQL) and a modified version of the Ablon scale were used to assess QoL and NF1 severity and visibility, respectively. Self-reported and parent-reported QoL scores were compared, and the associations between NF1 severity/visibility and QoL were explored. Results: Thirty-eight pediatric NF1 patients and their parents were enrolled. QoL scores did not differ significantly between patient self-reports and parent reports. However, correlational analyses revealed that higher NF1 severity was associated with lower physical QoL in patients, and greater NF1 visibility was linked to lower physical and social QoL. For parents, higher NF1 severity correlated with lower school functioning, whereas NF1 visibility did not show a significant correlation with QoL. Conclusion: The severity and visibility of NF1 have distinct impacts on various aspects of QoL in children, highlighting the need for tailored interventions that address both physical and psychological challenges. These findings underscore the importance of comprehensive care approaches in managing NF1 in pediatric populations.

Article: Family caregivers improve the diagnostic accuracy of disorders of consciousness: from remote to near-bed auditory stimulation - European Journal of Physical and Rehabilitation Medicine 2024 Feb 21 - Minerva Medica - Journals

Vertical neglect represents a visuospatial deficit occurring as a possible consequence of acquired brain injury (ABI). Differently from unilateral spatial neglect on horizontal space, vertical neglect is poorly studied in the literature and rarely assessed in clinical practice. In the available studies, the terms “radial,” “vertical,” and “altitudinal” neglect are often used interchangeably, although they do not describe the same spatial dimension. “Altitudinal” and “vertical” refer to the sagittal plane, whereas “radial” refers to the transverse plane. The term “vertical” is sometimes used interchangeably with respect to both axes. The aim of this systematic review was to identify the main characteristics of vertical neglect after ABI, the diagnostic tools used, and the treatment options. We also proposed a clarification of the manifestations and characteristics of vertical and radial neglect. The 23 articles reviewed, showed that the vertical neglect occurred more frequently on the lower space than on the upper space, that its presence was associated with horizontal neglect, and that it could also occur with compromise of the radial space, with the near radial being more common. The most frequent etiology associated with vertical neglect is vascular, particularly ischaemic. The lesions side are very heterogeneous and include both cortical and subcortical areas and all lobes, although the temporal lobe is most affected. With regard to the assessment tools, paper and pencil tasks are the most commonly used diagnostic tools to identify vertical neglect, although in recent years the use of computer-based tasks increased. Taken together, our results suggest that vertical neglect may be underestimated in patients with right hemisphere lesions and should always be assessed, especially in cases where the patient shows signs of horizontal neglect. The clinical assessment of vertical neglect is very important since it can lead to important functional limitations in everyday life, such as poor wheelchair handling, stumbling over unnoticed obstacles located below (or above), walking down stairs, taking off shoes.