Influence of Demographic and Clinical Factors on Perceived Usability, Presence, Flow, Competence, Pleasant and Unpleasant Sensations, and Utility During Interaction with Virtual Reality Games for Motor and Cognitive Rehabilitation: An Observational Study in Patients with Stroke and Traumatic Brain Injury.

User experience plays a crucial role in the interaction with virtual reality systems, especially in rehabilitation games for patients with brain injuries, who often face cognitive and motor challenges. User experience influences factors such as acceptance, engagement, and, importantly, the effectiveness of the intervention, all of which are key to achieving optimal recovery outcomes. While previous studies have examined the experiences of neurological populations, they have often focused on a single construct and used instruments that include irrelevant or confounding items.

Characterization of responders to transcranial direct current stimulation in disorders of consciousness: A retrospective study of 8 clinical trials.

The treatment for patients with disorders of consciousness challenges researchers and clinicians. The stimulation of the left dorsolateral prefrontal cortex with transcranial direct current stimulation (tDCS) may enhance behavioral responsiveness of a subset of patients in a minimally conscious state, while having limited effects in unresponsive patients. However, heterogeneity in responses raises questions about the effectiveness of tDCS.

Heart rate variability responses to personalized and non-personalized affective videos. A study on healthy subjects and patients with disorders of consciousness.

Introduction: The diagnosis of patients with disorders of consciousness (DOC), including those in a minimally conscious state (MCS) and those with unresponsive wakefulness syndrome (UWS), remains a significant clinical challenge. Neurobehavioral assessment primarily relies on motor responses to commands, which are often difficult to interpret due to impaired comprehension and cognitive-motor dissociation, resulting in a high rate of misdiagnosis. While electrical, hemodynamic, and metabolic brain responses, combined with personalized stimuli, have shown promise in improving diagnosis, the role of cardiac activity-less intrusive and time-efficient-remains underexplored.

Touchscreen-based assessment of upper limb kinematics after stroke: Reliability, validity and sensitivity to motor impairment.

Background: Conventional clinical tools for assessing upper limb motor function often lack the sensitivity and specificity needed to detect subtle changes in motor performance and may be subject to bias. Kinematic assessment offers a potential solution by providing objective, precise, and detailed data on movement quality. However, it is typically associated with high costs, complex equipment, time-consuming procedures, and the need for controlled environments, all of which limit its accessibility and practicality in clinical settings.

Aicardi-Goutières syndrome type 6: report of ADAR variant and clinical outcome after ruxolitinib treatment in the neonatal period.

Background: Aicardi-Goutières Syndrome is a monogenic type 1 interferonopathy with infantile onset, characterized by a variable degree of neurological damage. Approximately 7% of Aicardi-Goutières Syndrome cases are caused by pathogenic variants in the ADAR gene and are classified as Aicardi-Goutières Syndrome type 6. Here, we present a new homozygous pathogenic variant in the ADAR gene.

Ecological Validity of Self-Perceived Voice Quality and Acoustic Measures During Voice Assessments: An Observational Study on Faculty Teachers.

Purpose: This study investigated the ecological validity of conventional voice assessments by comparing the self-perceived voice quality and acoustic characteristics of voice production during these assessments to those in a simulated environment with varying distracting conditions and noise levels.

Method: Forty-two university professors (26 women) participated in the study, where they were asked to produce loud connected speech by reading a 100-word text under four different conditions: a conventional assessment and three virtual classroom simulations created with 360° videos, each with different noise levels, played through a virtual reality headset and headphones. The first video depicted students paying attention in class (40 dB classroom noise); the second showed some students talking, generating moderate conversational noise (60 dB); and the third depicted students talking loudly and not paying attention (70 dB).

EEG-based responses of patients with disorders of consciousness and healthy controls to familiar and non-familiar emotional videos.

Objective: To investigate the differences in the brain responses of healthy controls (HC) and patients with disorders of consciousness (DOC) to familiar and non-familiar audiovisual stimuli and their consistency with the clinical progress.

Methods: EEG responses of 19 HC and 19 patients with DOC were recorded while watching emotionally-valenced familiar and non-familiar videos. Differential entropy of the EEG recordings was used to train machine learning models aimed to distinguish brain responses to stimuli type.

Care bundle for preventing intraventricular hemorrhage in premature infants: a best practice implementation project.

Introduction: Intraventricular hemorrhages remain a major problem in neonatology, as their complications affect neonatal morbidity, mortality, and long-term neurodevelopmental outcomes.

Aim: The aim of this project was to prevent intraventricular hemorrhage in premature infants during their first days of life in a neonatal intensive care unit (NICU).

Methods: This pre- and post-implementation clinical audit project used the JBI Evidence Implementation Framework and was conducted in a tertiary-level Spanish NICU with a consecutive sample.

Searching molecular biomarkers correlating with BSID-III at 24 months in infants with neonatal hypoxic-ischemic encephalopathy.

An early prediction of outcomes of neonatal hypoxic-ischemic encephalopathy (NE) is of key importance in reducing neonatal mortality and morbidity. The objectives were (i) to analyze the characteristics of miRNA expression and metabolic patterns of neonates with NE and (ii) to assess their predictive performance for neurodevelopmental outcomes. Plasma samples from moderate/severe NE patients (N = 92) of the HYPOTOP study were collected before, during, and after therapeutic hypothermia (TH) and compared to a control group (healthy term infants).

Minimally conscious state plus versus minus: Likelihood of emergence and long-term functional independence.

Objective: Severe brain injuries can result in disorders of consciousness, such as the Minimally Conscious State (MCS), where individuals display intermittent yet discernible signs of conscious awareness. The varied levels of responsiveness and awareness observed in this state have spurred the progressive delineation of two subgroups within MCS, termed "plus" (MCS+) and "minus" (MCS-). However, the clinical validity of these classifications remains uncertain.

Which information derived from the Coma Recovery Scale-Revised provides the most reliable prediction of clinical diagnosis and recovery of consciousness? A comparative study using machine learning techniques.

Background: The Coma Recovery Scale-Revised (CRS-R) is the most recommended clinical tool to examine the neurobehavioral condition of individuals with disorders of consciousness (DOCs). Different studies have investigated the prognostic value of the information provided by the conventional administration of the scale, while other measures derived from the scale have been proposed to improve the prognosis of DOCs. However, the heterogeneity of the data used in the different studies prevents a reliable comparison of the identified predictors and measures.

Identifying and regulating emotions after acquired brain injury: the role of interoceptive sensibility.

Introduction: Interoceptive deficits are associated with difficulties in identifying and regulating emotions. However, research on interoception after acquired brain injury (ABI) is scarce, and its relationship with emotional difficulties in this population is unknown. This study aimed to (1) examine differences in self-reported alexithymia, performance-based emotional awareness, emotion regulation, depression, and interoceptive sensibility between ABI and control individuals; and (2) analyze the role of adaptive interoceptive dimensions in these emotional processes after ABI.

Ecologically valid virtual reality-based technologies for assessment and rehabilitation of acquired brain injury: a systematic review.

Purpose: A systematic review was conducted to examine the state of the literature regarding using ecologically valid virtual environments and related technologies to assess and rehabilitate people with Acquired Brain Injury (ABI).

Materials And Methods: A literature search was performed following the PRISMA guidelines using PubMed, Web of Science, ACM and IEEE databases. The focus was on assessment and intervention studies using ecologically valid virtual environments (VE).

Sham-controlled randomized multicentre trial of transcranial direct current stimulation for prolonged disorders of consciousness.

Background And Purpose: Transcranial direct current stimulation (tDCS) has been shown to improve signs of consciousness in a subset of patients with disorders of consciousness (DoC). However, no multicentre study confirmed its efficacy when applied during rehabilitation. In this randomized controlled double-blind study, the effects of tDCS whilst patients were in rehabilitation were tested at the group level and according to their diagnosis and aetiology to better target DoC patients who might repond to tDCS.

Preterm-related posthemorrhagic hydrocephalus: Review of our institutional series with a long-term follow-up.

Introduction: Preterm-related posthemorrhagic hydrocephalus is a major cause of neurological impairment and a common indication for a ventriculoperitoneal shunt in infants that are prone to diverse complications. Protocols of diagnosis and treatment are in continuous evolution and require evaluation of their results.

Objective: To review the clinical characteristics and results of a series of preterm-related posthemorrhagic hydrocephalus needing a definitive shunt from 1982 to 2020 in our institution.

Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial.

Background: Functional impairments derived from the non-use of severely affected upper limb after stroke have been proposed to be mitigated by action observation and imagination-based techniques, whose effectiveness is enhanced when combined with transcranial direct current stimulation (tDCS). Preliminary studies in mildly impaired individuals in the acute phase post-stroke show intensified effects when action is facilitated by tDCS and mediated by virtual reality (VR) but the effectiveness in cases of severe impairment and chronic stroke is unknown. This study investigated the effectiveness of a combined tDCS and VR-based intervention in the sensorimotor function of chronic individuals post-stroke with persistent severe hemiparesis compared to conventional physical therapy.

Evaluation of a Low-Cost Virtual Reality Surround-Screen Projection System.

Two of the most popular mediums for virtual reality are head-mounted displays and surround-screen projection systems, such as CAVE Automatic Virtual Environments. In recent years, HMDs suffered a significant reduction in cost and have become widespread consumer products. In contrast, CAVEs are still expensive and remain accessible to a limited number of researchers.

Behavioral signs of recovery from unresponsive wakefulness syndrome to emergence of minimally conscious state after severe brain injury.

Precise description of behavioral signs denoting transition from unresponsive wakefulness syndrome/vegetative state (UWS/VS) to minimally conscious state (MCS) or emergence from MCS after severe brain injury is crucial for prognostic purposes. A few studies have attempted this goal but involved either non-standardized instruments, limited temporal accuracy or samples, or focused on (sub)acute patients. The objective of this study was to describe the behavioral signs that led to a change of diagnosis, as well as the factors influencing this transition, in a large sample of patients with chronic disorders of consciousness after severe brain injury.

Validity, reliability, and sensitivity to motor impairment severity of a multi-touch app designed to assess hand mobility, coordination, and function after stroke.

Background: The assessment of upper-limb motor impairments after stroke is usually performed using clinical scales and tests, which may lack accuracy and specificity and be biased. Although some instruments exist that are capable of evaluating hand functions and grasping during functional tasks, hand mobility and dexterity are generally either not specifically considered during clinical assessments or these examinations lack accuracy. This study aimed to determine the convergent validity, reliability, and sensitivity to impairment severity after a stroke of a dedicated, multi-touch app, named the Hand Assessment Test.

Validation of Using Smartphone Built-In Accelerometers to Estimate the Active Energy Expenditures of Full-Time Manual Wheelchair Users with Spinal Cord Injury.

This study aimed to investigate the validity of using built-in smartphone accelerometers to estimate the active energy expenditures of full-time manual wheelchair users with spinal cord injury (SCI). Twenty participants with complete SCI completed 10 5-min daily activities that involved the upper limbs, during which their oxygen consumption and upper limb activity were registered using a portable gas analyzer and a smartphone (placed on the non-dominant arm), respectively. Time series of 1-min averaged oxygen consumption and 55 accelerometer variables (13 variables for each of the four axes and three additional variables for the correlations between axes) were used to estimate three multiple linear models, using a 10-fold cross-validation method.

When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Neurobehavioral Progress.

Accurate estimation of the neurobehavioral progress of patients with unresponsive wakefulness syndrome (UWS) is essential to anticipate their most likely clinical course and guide clinical decision making. Although different studies have described this progress and possible predictors of neurobehavioral improvement in these patients, they have methodological limitations that could restrict the validity and generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the prognostic factors of changes in their neurobehavioral condition.

When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence.

Accurate estimation of the functional independence of patients with unresponsive wakefulness syndrome (UWS) is essential to adjust family and clinical expectations and plan long-term necessary resources. Although different studies have described the clinical course of these patients, they have methodological limitations that could restrict generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the functional independence staging of those patients who emerged from a minimally conscious state (MCS) during the first year post-emergence.