PubMed | Messina University and a IRCCS Centro Neurolesi Bonino Pulejo Messina
Type: Journal Article | Journal: Brain injury | Year: 2016
The diagnosis of Disorders of Consciousness (DOC) is still challenging. Indeed, ~ 40% of patients in vegetative state (VS) are misdiagnosed, suggesting the need of more appropriate diagnostic tools. Emerging data are showing that EEG, including sleep structure evaluation and multimodal evoked potential recording could be helpful in DOC diagnosis. Moreover, pain perception evaluation could further increase diagnosis accuracy in such individuals.Fourteen individuals with DOC, due to severe brain injury, were enrolled and admitted to the Intensive Neurorehabilitation Unit of the Research Institute. All patients were evaluated by means of the Coma Recovery Scale-Revised, a 24(hh)-polysomnography and a Laser Evoked Potential (LEP) paradigm.Clinically-defined patients in Minimally Consciousness State showed a more preserved sleep structure, physiologic hypnic figures and preserved REM/NREM sleep distribution than subjects in VS. LEP showed increased latencies and reduced amplitudes and were also detectable in patients with more structured sleep.The data support previous findings concerning the importance of sleep study in DOC diagnosis, with more specific neurophysiological paradigms. Interestingly, the findings shed some light on the possible correlations among global brain connectivity, sleep structure and pain perception, which are related to the activity of the wide thalamo-cortical and cortico-cortical networks underlying consciousness.
PubMed | a IRCCS Centro Neurolesi Bonino Pulejo Messina
Type: | Journal: The journal of spinal cord medicine | Year: 2016
Spinal cord injury (SCI) affects more than 2.5 million people worldwide, often leading to severe disability. Thus, a proper management of individuals with SCI is required either in the acute or in the post-acute rehabilitative phase.A 31-year-old man, affected by chronic SCI, underwent two different intensive rehabilitation treatments, including either LokomatPro or a paired LokomatPro-rTMS training. We evaluated the clinical, kinetic, and electrophysiological parameters before and after each training session. In particular, the intensive robotic training was articulated in a total of 40 one-hour training sessions (i.e. 5 times a week for 8 weeks), whereas the rTMS sessions were delivered 3 days per week for 3 consecutive weeks, just before the LokomatPro session. Only at the end of the experimental treatment, we observed an important improvement in nearly all parameters we investigated.The combined LokomatPro-rTMS rehabilitation may be a valuable approach in improving the motor function in patients affected by SCI, even in the chronic phase.