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Prior studies have shown that patients suffering from chronic Low Back Pain (cLBP) have impaired somatosensory processing including reduced tactile acuity, i.e. reduced ability to resolve fine spatial details with the perception of touch. The central mechanism(s) underlying reduced tactile acuity are unknown but may include changes in specific brain circuitries (e.g. neuroplasticity in the primary somatosensory cortex, S1). Furthermore, little is known about the linkage between changes in tactile acuity and the amelioration of cLBP by somatically-directed therapeutic interventions, such as acupuncture. In this longitudinal neuroimaging study, we evaluated healthy control adults (HC, N ​= ​50) and a large sample of cLBP patients (N ​= ​102) with structural brain imaging (T1-weighted MRI for Voxel-Based Morphometry, VBM; Diffusion Tensor Imaging, DTI) and tactile acuity testing using two-point discrimination threshold (2PDT) over the lower back (site of pain) and finger (control) locations. Patients were evaluated at baseline and following a 4-week course of acupuncture, with patients randomized to either verum acupuncture, two different forms of sham acupuncture (designed with or without somatosensory afference), or no-intervention usual care control. At baseline, cLBP patients demonstrated reduced acuity (greater 2PDT, P ​= ​0.01) over the low back, but not finger (P ​= ​0.29) locations compared to HC, suggesting that chronic pain affects tactile acuity specifically at body regions encoding the experience of clinical pain. At baseline, Gray Matter Volume (GMV) was elevated and Fractional Anisotropy (FA) was reduced, respectively, in the S1-back region of cLBP patients compared to controls (P ​< ​0.05). GMV in cLBP correlated with greater 2PDT-back scores (ρ ​= ​0.27, P ​= ​0.02). Following verum acupuncture, tactile acuity over the back was improved (reduced 2PDT) and greater improvements were associated with reduced S1-back GMV (ρ ​= ​0.52, P ​= ​0.03) and increased S1-back adjacent white matter FA (ρ ​= ​−0.56, P ​= ​0.01). These associations were not seen for non-verum control interventions. Thus, S1 neuroplasticity in cLBP is linked with deficits in tactile acuity and, following acupuncture therapy, may represent early mechanistic changes in somatosensory processing that track with improved tactile acuity.

This patient was left with visual agnosia after developing herpes simplex encephalitis at a young age. She describes her strategies for coping with this visual disability

Unawareness of impairment (anosognosia) is a phenomenon associated with right hemisphere lesions. Unawareness of emotion has rarely been studied. Patients (N = 50) with poststroke major depression were administered the Toronto, Ontario, Canada, Alexithymia Scale to assess impairment in identifying feelings (F1), describing feelings (F2), and externally oriented thinking (F3). After eight weeks of treatment with sertraline or fluoxetine, patients were reassessed. Alexithymia was significantly associated with right hemisphere lesions. Patients with alexithymia had a significant improvement in identifying and describing feelings, but not in externally oriented thinking. In addition, cognitive functions improved after antidepressant treatment in patients without alexithymia with left lesions only. On the contrary, functional activities of daily living and depressive symptoms improved both in patients with alexithymia and those without alexithymia. The unawareness of emotions is a common impairment after right hemisphere stroke. This disorder may be significantly improved by antidepressant treatment.

Objective: To evaluate the effects of individual or group mirror therapy on sensorimotor function, activities of daily living, quality of life and visuospatial neglect in patients with a severe arm paresis after stroke. Design: Randomized controlled trial. Setting: Inpatient rehabilitation centre. Subject: Sixty patients with a severe paresis of the arm within three months after stroke. Interventions: Three groups: (1) individual mirror therapy, (2) group mirror therapy and (3) control intervention with restricted view on the affected arm. Main measures: Motor function on impairment (Fugl-Meyer Test) and activity level (Action Research Arm Test), independence in activities of daily living (Barthel Index), quality of life (Stroke Impact Scale) and visuospatial neglect (Star Cancellation Test). Results: After five weeks, no significant group differences for motor function were found (P > 0.05). Pre–post differences for the Action Research Arm Test and Fugl-Meyer Test: individual mirror therapy: 3.4 (7.1) and 3.2 (3.8), group mirror therapy: 1.1 (3.1) and 5.1 (10.0) and control therapy: 2.8 (6.7) and 5.2 (8.7). However, a significant effect on visuospatial neglect for patients in the individual mirror therapy compared to control group could be shown (P < 0.01). Furthermore, it was possible to integrate a mirror therapy group intervention for severely affected patients after stroke. Conclusion: This study showed no effect on sensorimotor function of the arm, activities of daily living and quality of life of mirror therapy compared to a control intervention after stroke. However, a positive effect on visuospatial neglect was indicated.

Chronic opioid exposure is common world-wide, but behavioural performance remains under-investigated. This study aimed to investigate visuospatial memory performance in opioid-exposed and dependent clinical populations and its associations with measures of intelligence and cognitive impulsivity. We recruited 109 participants: (i) patients with a history of opioid dependence due to chronic heroin use (n = 24), (ii) heroin users stabilised on methadone maintenance treatment (n = 29), (iii) participants with a history of chronic pain and prescribed tramadol and codeine (n = 28) and (iv) healthy controls (n = 28). The neuropsychological tasks from the Cambridge Neuropsychological Test Automated Battery included the Delayed Matching to Sample (DMS), Pattern Recognition Memory, Spatial Recognition Memory, Paired Associate Learning, Spatial Span Task, Spatial Working Memory and Cambridge Gambling Task. Pre-morbid general intelligence was assessed using the National Adult Reading Test. As hypothesised, this study identified the differential effects of chronic heroin and methadone exposures on neuropsychological measures of visuospatial memory (p < 0.01) that were independent of injecting behaviour and dependence status. The study also identified an improvement in DMS performance (specifically at longer delays) when the methadone group was compared with the heroin group and also when the heroin group was stabilised onto methadone. Results identified differential effects of chronic heroin and methadone exposures on various neuropsychological measures of visuospatial memory independently from addiction severity measures, such as injecting behaviour and dependence status.

The Visual Brain and Peripheral Reading and Writing Disorders: A Guide to Visual System Dysfunction for Speech-Language Pathologists familiarizes the reader with the complex workings of the human visual system, the motor and sensory components of normal vision as they relate to the recognition of letters and words.

How can individuals adhere to an intervention plan or access health and social care services if they are unaware of their need for assistance? Anosognosia, defined as the lack of awareness of one's pathological condition, affects 20-40% of people living with major neurocognitive disorders (MNCD), such as Alzheimer's disease, even in its early stages. Rooted in memory impairments and prefrontal brain region dysfunction, anosognosia often causes individuals to overestimate their abilities, identify with a prior state of health, and oppose proposed interventions. This opposition undermines care plans, exhausts caregivers, and frequently results in crises such as unsafe behaviors, avoidable hospitalization, or institutionalization. Multidimensional assessments play a critical role in addressing this complexity. Through neuropsychological testing, caregiver-reported measures, neuroimaging (MRI, PET), and biomarkers, it's possible to identify key deficits that influence opposition to care and limit the effectiveness of standard and adapted interventions. Importantly, our studies demonstrated that anosognosia leads to impaired risk awareness and decision-making, rooted in prefrontal and limbic brain dysfunction. For this reason, Alzheimer's disease should be seen more as a \"adaptability disease\" than a \"memory disease\". These findings underline the urgent need for standardized evaluation tools and practices that are sensitive to these specific deficits. Our research can support innovative care pathways that prioritize adaptability by analyzing the discourse of individuals with major neurocognitive disorders (MNCD). This analysis reveals patterns of overestimation of functional abilities, which lead to increased safety risks and care refusal. Our work underscores the importance of co-designed care strategies that leverage technology-such as sensor-based monitoring systems and AI tools-to dynamically address risk management. Additionally, insights into how intersectoral collaboration, guided by frameworks such as Quebec's Alzheimer Plan and policy, can bridge gaps between clinical research and real-world care implementation will be shared. Ultimately, offering actionable recommendations can enhance the assessment and care of individuals with Alzheimer's disease, while emphasizing the integration of cutting-edge research into evolving, person-centered practices.

In recent years, the stroke incidence has been increasing year by year, and the related sequelae after stroke, such as cognitive impairment, motor dysfunction, and post-stroke depression, seriously affect the patient’s rehabilitation and daily activities. Repetitive transcranial magnetic stimulation (rTMS), as a safe, non-invasive, and effective new rehabilitation method, has been widely recognized in clinical practice. This article reviews the application and research progress of rTMS in treating different functional impairments (cognitive impairment, motor dysfunction, unilateral spatial neglect, depression) after stroke in recent years, and preliminary summarized the possible mechanisms. It has been found that the key parameters that determine the effectiveness of rTMS in improving post-stroke functional impairments include pulse number, stimulated brain areas, stimulation intensity and frequency, as well as duration. Generally, high-frequency stimulation is used to excite the ipsilateral cerebral cortex, while low-frequency stimulation is used to inhibit the contralateral cerebral cortex, thus achieving a balance of excitability between the two hemispheres. However, the specific mechanisms and the optimal stimulation mode for different functional impairments have not yet reached a consistent conclusion, and more research is needed to explore and clarify the best way to use rTMS. Furthermore, we will identify the issues and challenges in the current research, explore possible mechanisms to deepen understanding of rTMS, propose future research directions, and offer insightful insights for better clinical applications.