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After prolonged stay in an intensive care unit (ICU) patients often complain about cognitive impairments that affect health-related quality of life after discharge. The aim of this proof-of-concept study was to test the feasibility and effects of controlled visual and acoustic stimulation in a virtual reality (VR) setup in the ICU. The VR setup consisted of a head-mounted display in combination with an eye tracker and sensors to assess vital signs. The stimulation consisted of videos featuring natural scenes and was tested in 37 healthy participants in the ICU. The VR stimulation led to a reduction of heart rate (p = 0. 049) and blood pressure (p = 0.044). Fixation/saccade ratio (p < 0.001) was increased when a visual target was presented superimposed on the videos (reduced search activity), reflecting enhanced visual processing. Overall, the VR stimulation had a relaxing effect as shown in vital markers of physical stress and participants explored less when attending the target. Our study indicates that VR stimulation in ICU settings is feasible and beneficial for critically ill patients.

Traumatic brain injury (TBI) and its potential long-term consequences are of major concern for public health. Neurorehabilitation of affected individuals has some specific characteristics in contrast to neurorehabilitation of patients with acquired brain lesions of other aetiology. This review will deal with the clinical consequences of the distinct lesions of TBI. In severe TBI, clinical course often follows a typical initial sequence of coma; followed by disturbed consciousness; later, post-traumatic agitation and amnesia; and finally, recovery of function occurs. In the different phases of neurorehabilitation, physicians should be aware of typical medical complications such as paroxysmal sympathetic hyperactivity, posttraumatic hydrocephalus, and posttraumatic neuroendocrine dysfunctions. Furthermore, we address questions on timing and on existing evidence for different rehabilitation programmes and for holistic neuropsychological rehabilitation approaches.

Background The thalamus plays a key role in motor and sensory processes of the brain. Though thalamic stroke is among the less frequent, even a minimal lesion can result in a serious impairment and long-lasting disability. After thalamic stroke, cases of dysexecutive syndrome and so-called diencephalic amnesia have been observed, yet the precise characterisation or categorisation of such amnestic syndrome is not available. Pure amnesia can be the one and only indication of a thalamic lesion. We present a unique case of a patient after left anterolateral thalamic stroke suffering from isolated severe amnesia and disorientation. We conducted extensive neuropsychological testing of the patient’s memory and discovered contrasting results in different aspects of memory. Case presentation A 75-year-old woman was admitted for neurological rehabilitation two weeks after being diagnosed with acute left anterolateral thalamic ischemic stroke. The initial symptoms with which she presented in the emergency room were acute confusion, disorientation and memory impairment; apart from that, the patient did not have any other neurologic signs. As observed on the MRI, the lesion was restricted mostly to the left anterior nucleus without affecting the mammillothalamic tract. The neuropsychological testing revealed anterograde episodic memory loss with preserved visual recognition and auditive short term memory; inability to freely recall semantic information, spatial and time disorientation, apathy and significantly reduced intrinsic and phasic attention, and immediate and delayed prose recall deficiency. Conclusion The knowledge that memory impairment and disorientation can be the only symptoms of the stroke is a crucial piece of information, which is needed to be able to make a decision about proper treatment. Abstention from immediate intervention often leads to irreparable memory deficit for the rest of the patient’s life. The results of neuropsychological testing show the essential role of AN in creating episodic memory, in the working memory network and indicate its role as a critical interface between short-term and long-term memory. A theory explaining such a profound impairment of working and anterograde episodic memory has not yet been formulated.

Despite growing interest in developing ecological assessment of difficulties in patients with Alzheimer's disease new methods assessing the cognitive difficulties related to functional activities are missing. To complete current evaluation, the use of Serious Games can be a promising approach as it offers the possibility to recreate a virtual environment with daily living activities and a precise and complete cognitive evaluation. The aim of the present study was to evaluate the usability and the screening potential of a new ecological tool for assessment of cognitive functions in patients with Alzheimer's disease. Eighteen patients with Alzheimer's disease and twenty healthy controls participated to the study. They were asked to complete six daily living virtual tasks assessing several cognitive functions: three navigation tasks, one shopping task, one cooking task and one table preparation task following a one-day scenario. Usability of the game was evaluated through a questionnaire and through the analysis of the computer interactions for the two groups. Furthermore, the performances in terms of time to achieve the task and percentage of completion on the several tasks were recorded. Results indicate that both groups subjectively found the game user friendly and they were objectively able to play the game without computer interactions difficulties. Comparison of the performances between the two groups indicated a significant difference in terms of percentage of achievement of the several tasks and in terms of time they needed to achieve the several tasks. This study suggests that this new Serious Game based assessment tool is a user-friendly and ecological method to evaluate the cognitive abilities related to the difficulties patients can encounter in daily living activities and can be used as a screening tool as it allowed to distinguish Alzheimer's patient's performance from healthy controls.

Introduction There is currently a lack of easy-to-use and effective robotic devices for upper-limb rehabilitation after stroke. Importantly, most current systems lack the provision of somatosensory information that is congruent with the virtual training task. This paper introduces a novel haptic robotic system designed for upper-limb rehabilitation, focusing on enhancing sensorimotor rehabilitation through comprehensive haptic rendering. Methods We developed a novel haptic rehabilitation device with a unique combination of degrees of freedom that allows the virtual training of functional reach and grasp tasks, where we use a physics engine-based haptic rendering method to render whole-hand interactions between the patients’ hands and virtual tangible objects. To evaluate the feasibility of our system, we performed a clinical mixed-method usability study with seven patients and seven therapists working in neurorehabilitation. We employed standardized questionnaires to gather quantitative data and performed semi-structured interviews with all participants to gain qualitative insights into the perceived usability and usefulness of our technological solution. Results The device demonstrated ease of use and adaptability to various hand sizes without extensive setup. Therapists and patients reported high satisfaction levels, with the system facilitating engaging and meaningful rehabilitation exercises. Participants provided notably positive feedback, particularly emphasizing the system’s available degrees of freedom and its haptic rendering capabilities. Therapists expressed confidence in the transferability of sensorimotor skills learned with our system to activities of daily living, although further investigation is needed to confirm this. Conclusion The novel haptic robotic system effectively supports upper-limb rehabilitation post-stroke, offering high-fidelity haptic feedback and engaging training tasks. Its clinical usability, combined with positive feedback from both therapists and patients, underscores its potential to enhance robotic neurorehabilitation.

Background and Purpose Patients with postural tachycardia syndrome report position‐dependent visual symptoms. Despite their impact on daily life, these symptoms have remained largely unexplored in research. The aim of this study was to investigate the nature of visual symptoms in postural tachycardia syndrome and possible underlying pathophysiological mechanisms. Methods Fifteen patients with postural tachycardia syndrome and 15 healthy controls were included in the study. Through a comprehensive array of measurements, including haemodynamics, subjective symptom assessments, eye movement tracking and pupil diameter analysis, participants were assessed during free image exploration in both supine and 60° head‐up tilt positions. Results During head‐up tilt, patients showed a decreased number and duration of fixations, as well as a decreased number, peak velocity and amplitude of saccades compared to the supine position and the control group. This reduction in visual exploration occurred primarily in the peripheral field of view and coincided with the occurrence of subjective visual symptoms. No significant differences in the saccade main sequence were observed between the two groups in either body position. Conclusions Patients with postural tachycardia syndrome have a reduced exploration of the peripheral field of view when in an upright body position, potentially leading to tunnel vision. Since the normality of the saccade main sequence in patients combined with the focus on the centre of the field of view and the lower saccade amplitudes points to an intact brainstem function, the decrease in peripheral visual exploration may be attributed to a position‐dependent dysfunction of the frontal eye field. The results of the present study demonstrate as a primary finding a position‐dependent alteration of visual exploration behaviour in patients with postural tachycardia syndrome. Specifically, a reduced peripheral visual exploration in the upright position became apparent, possibly leading to tunnel vision in patients. This phenomenon represents a potential explanation for the occurrence of some of the visual symptoms in postural tachycardia syndrome and is probably associated with a position‐dependent functional disturbance of the frontal lobe, especially the frontal eye field. The figure shows an exemplary visualization of gaze behaviour of patients with postural tachycardia syndrome and control subjects in the supine and upright body positions. The warmth of the colour and size of the spots represent the number and duration of fixation; that is, the warmer the colour, the more and longer participants fixated the spot.

One of the leading approaches to non-invasively treat a variety of brain disorders is transcranial magnetic stimulation (TMS). However, despite its clinical prevalence, very little is known about the action of TMS at the cellular level let alone what effect it might have at the subcellular level (e.g. dendrites). Here, we examine the effect of single-pulse TMS on dendritic activity in layer 5 pyramidal neurons of the somatosensory cortex using an optical fiber imaging approach. We find that TMS causes GABAB-mediated inhibition of sensory-evoked dendritic Ca2+ activity. We conclude that TMS directly activates fibers within the upper cortical layers that leads to the activation of dendrite-targeting inhibitory neurons which in turn suppress dendritic Ca2+ activity. This result implies a specificity of TMS at the dendritic level that could in principle be exploited for investigating these structures non-invasively. The brain’s billions of neurons communicate with one another using electrical signals. Applying a magnetic field to a small area of the scalp can temporarily disrupt these signals by inducing small electrical currents in the brain tissue underneath. The currents interfere with the brain’s own electrical signals and temporarily disrupt the activity of the stimulated brain region. This technique, which is known as transcranial magnetic stimulation, is often used to investigate the roles of specific brain regions. By examining what happens when a region is briefly taken ‘offline’, it is possible to deduce what that area normally does. Transcranial magnetic stimulation is also used to treat brain disorders ranging from epilepsy to schizophrenia without the need for surgery or drugs. But despite its widespread usage, little is known about how transcranial magnetic stimulation affects individual neurons. Neurons are made up of a cell body, which has numerous short branches called dendrites, and a cable-like structure called the axon. Neurons signal to each other by releasing chemical messengers across junctions called synapses. The chemical signals are generally released from the axon of one neuron and bind to receptor proteins on a dendrite on another neuron to stimulate electrical activity in the receiving neuron. Murphy et al. have now investigated how transcranial magnetic stimulation affects the activity of dendrites from neurons within the cortex of the rat brain. This revealed that the magnetic fields stimulate other neurons that inhibit the activity of dendrites from neurons within the deeper layers of the cortex. The inhibition process depends on a type of receptor protein in the dendrites called GABAB receptors; blocking these receptors prevents transcranial magnetic stimulation from altering the activity of stimulated brain regions. The processes occurring in these dendrites have been linked to cognitive function. The next challenge will be to integrate the non-invasive transcranial magnetic stimulation approach with cognitive tests in humans that can now manipulate dendritic activity to test their importance under various circumstances.

In older adults, physical activity is crucial for healthy aging and associated with numerous health indicators and outcomes. Regular assessments of physical activity can help detect early health-related changes and manage physical activity targeted interventions. The quantification of physical activity, however, is difficult as commonly used self-reported measures are biased and rather unprecise point in time measurements. Modern alternatives are commonly based on wearable technologies which are accurate but suffer from usability and compliance issues. In this study, we assessed the potential of an unobtrusive ambient-sensor based system for continuous, long-term physical activity quantification. Towards this goal, we analysed one year of longitudinal sensor- and medical-records stemming from thirteen community-dwelling old and oldest old subjects. Based on the sensor data the daily number of room-transitions as well as the raw sensor activity were calculated. We did find the number of room-transitions, and to some degree also the raw sensor activity, to capture numerous known associations of physical activity with cognitive, well-being and motor health indicators and outcomes. The results of this study indicate that such low-cost unobtrusive ambient-sensor systems can provide an adequate approximation of older adults’ overall physical activity, sufficient to capture relevant associations with health indicators and outcomes.

: Unilateral spatial neglectis an attention disorder frequently occurring after a right-hemispheric stroke. Neglect results in a reduction in qualityof life and performance in activities of daily living. With current technical improvements in virtual reality (VR) technology, trainingwith stereoscopic head-mounted displays (HMD) has become a promising new approach for the assessment and the rehabilitation of neglect. The focus of this pilot study was to develop and evaluate a simple visual search task in VR for HMD. The VR system was tested regarding feasibility, acceptance, and potential adverse effects in healthy controls and right-hemispheric stroke patients with and without neglect. : The VR system consisted of two main components, a head-mounted display to present the virtual environment, and a hand-held controller for the interaction with the latter. The task followed the rationale of diagnostic paper-pencil cancellation tasks; i.e., the participants were asked to search targets among distractors. However, instead of a two-dimensional setup, the targets and distractors were arranged in three dimensions, in a sphere around the subject inside its field of view. Usability and acceptance of the task, as well as the performance in the latter, were tested in 15 right-hemispheric subacute stroke patients (10 of whom with and five of whom without unilateral spatial neglect; mean age: 67.1 ± 10.5 years) and 35 age-matched healthy controls. : System usability and acceptance were rated as high both in stroke patients and healthy controls, close to the maximum score of the questionnaire scale. No relevant adverse effects occurred. There was a high correlation ( = 0.854, = 0.002) between the Center of Cancellation [an objective neglect measure) calculated from a paper-pencil cancellation task (Sensitive Neglect Test (SNT)] and the newly developed VR cancellation task. : Overall, the developed visual search task in the tested VR system is feasible, well-accepted, enjoyable, and does not evoke any significant negative effects, both for healthy controls and for stroke patients. Findings for task performance show that the ability of the VR cancellation to detect neglect in stroke patients is similar to paper-pencil cancellation tasks.

Parallel test versions require a comparable degree of difficulty and must capture the same characteristics using different items. This can become challenging when dealing with multivariate items, which are for example very common in language or image data. Here, we propose a heuristic to identify and select similar multivariate items for the generation of equivalent parallel test versions. This heuristic includes: 1. inspection of correlations between variables; 2. identification of outlying items; 3. application of a dimension-reduction method, such as for example principal component analysis (PCA); 4. generation of a biplot, in case of PCA of the first two principal components (PC), and grouping the displayed items; 5. assigning of the items to parallel test versions; and 6. checking the resulting test versions for multivariate equivalence, parallelism, reliability, and internal consistency. To illustrate the proposed heuristic, we applied it exemplarily on the items of a picture naming task. From a pool of 116 items, four parallel test versions were derived, each containing 20 items. We found that our heuristic can help to generate parallel test versions that meet requirements of the classical test theory, while simultaneously taking several variables into account.