Lucia Lucca - Academia.edu (original) (raw)

Papers by Lucia Lucca

BMC Neurology, 2015

Background: Despite evidence from neuroimaging research, diagnosis and early prognosis in the veg... more Background: Despite evidence from neuroimaging research, diagnosis and early prognosis in the vegetative (VS/UWS) and minimally conscious (MCS) states still depend on the observation of clinical signs of responsiveness. Multiple testing has documented a systematic variability during the day in the incidence of established signs of responsiveness. Spontaneous fluctuations of the Coma Recovery Scale-revised (CRS-r) scores are conceivable. Methods: We retrospectively analyzed the CRS-r repeatedly administered to 7 VS/UWS and 12 MCS subjects undergoing systematic observation during a conventional 13 weeks. rehabilitation plan. Results: The CRS-r global, visual and auditory scores were found higher in the morning than at the afternoon administration in both VS/UWS and MCS subgroups over the entire period of observation. The probability for a VS/UWS subject of being classified as MCS at the morning testing at least once during the 13 weeks. observation was as high as 30 %, i.e., compatible with the reported misdiagnosis rate between the two clinical conditions. Conclusions: Multiple CRS-r testing is advisable to minimize the risk of misclassification; estimates of spontaneous variability could be used to characterize with greater accuracy patients with disorder of consciousness and possibly help optimize the rehabilitation plan.

Brain Injury, 2020

Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (... more Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state-MCS) and in different etiologies.. Design: Multi-center cross-sectional observational study. Setting: 23 intensive neurorehabilitation units. Subjects: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury. Main Measures: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications. Results: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology. Conclusion: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.

European Journal of Physical and Rehabilitation Medicine, 2020

This paper reports the immediate impact of the epidemic on rehabilitation services in Italy, the ... more This paper reports the immediate impact of the epidemic on rehabilitation services in Italy, the first country in Europe hit by Covid-19. In a country with almost 5,000 Physical and Rehabilitation Medicine physicians, the webinar had 230 live viewers (4.5%), and more than 8,900 individual visualizations of the recorded version. The overall inadequate preparation of the rehabilitation system to face a sudden epidemic was clear, and similar to that of the acute services. The original idea of confining the Covid-19 cases to some areas of rehabilitation wards and/or hospitals, preserving others, proved not to be feasible. Continuous reorganization and adaptation were required due to the rapid changes. Overall, rehabilitation needs had to surrender to the more acute emergency, with total conversion of beds, wards and even hospitals. The quarantine needs heavily involved also outpatient services that were mostly closed. Rehabilitation professionals needed support, but also acted properly, again similarly to what happened in the acute wards. The typical needs of rehabilitation, such as human and physical contacts, but also social interactions including patient, team, family and caregivers, appeared clearly in the current unavoidable need of being suppressed. These notes could serve the preparation of other services worldwide.

Journal of Neurotrauma, 2019

The rate of paroxysmal sympathetic hyperactivity (PSH) was retrospectively assessed using the Par... more The rate of paroxysmal sympathetic hyperactivity (PSH) was retrospectively assessed using the Paroxysmal Sympathetic Hyperactivity-Assessment Measure (PSH-AM) scale in patients with disorders of consciousness attributed to traumatic and non-traumatic acquired brain injury during the rehabilitation phase. These results were compared with previous studies carried out in the same clinical scenario, in order to verify the prevalence of PSH signs from 1998 to 2014. The entire sample consisted of 140 patients in vegetative state/unresponsive wakefulness syndrome or minimally conscious state admitted to a neurorehabilitation subacute unit from June 2010 to December 2014. PSH-AM revealed the presence of PSH in 16% of traumatic and 12% of non-traumatic younger patients. In the non-traumatic group, the rate was higher in patients with anoxia-hypoxia (37.5%) etiology than those with vascular brain injury (6.7%). A comparison with previous studies revealed a reduction in the number of PSH cases in traumatic patients. This study provides evidence that PSH-AM can be used prospectively to detect the rate of PSH and stratify severity of signs. Further longitudinal analysis is warranted to confirm the prevalence of PSH signs in non-traumatic brain injured patients.

Biomedicines, 2022

One of the main challenges in traumatic brain injury (TBI) patients is to achieve an early and de... more One of the main challenges in traumatic brain injury (TBI) patients is to achieve an early and definite prognosis. Despite the recent development of algorithms based on artificial intelligence for the identification of these prognostic factors relevant for clinical practice, the literature lacks a rigorous comparison among classical regression and machine learning (ML) models. This study aims at providing this comparison on a sample of TBI patients evaluated at baseline (T0), after 3 months from the event (T1), and at discharge (T2). A Classical Linear Regression Model (LM) was compared with independent performances of Support Vector Machine (SVM), k-Nearest Neighbors (k-NN), Naïve Bayes (NB) and Decision Tree (DT) algorithms, together with an ensemble ML approach. The accuracy was similar among LM and ML algorithms on the analyzed sample when two classes of outcome (Positive vs. Negative) approach was used, whereas the NB algorithm showed the worst performance. This study highlight...

ARAMIS (Automatic Recovery Arm Motility Integrated System) is a dual exoskeleton robot, intended ... more ARAMIS (Automatic Recovery Arm Motility Integrated System) is a dual exoskeleton robot, intended to provide the therapist with novel and time/cost efficient approach to the rehabilitation of the paretic upper limb after stroke. The system has been developed in order to enable therapists to define and apply patient-specific rehabilitation exercises with multidisciplinary support by neurologist, engineers, ICT specialists and designers. ARAMIS allows three main strategies: 1) Asynchronous Exercise 2) Synchronous Exercise and 3) Virtual Exercise. This paper reports preliminary results from a patients' sample trained by ARAMIS.

Functional neurology

The aim of this study was to validate the Progression of Autonomies Scale (PAS) for the evaluatio... more The aim of this study was to validate the Progression of Autonomies Scale (PAS) for the evaluation of autonomies in severe acquired brain injury patients. The PAS design is based on a model of progressive recovery of autonomies and is organized in three domains (Personal, Domestic and Extra-domestic). Scores assigned range from zero to three. The PAS items gather information about the patient's perception and awareness of his/her disability(ies) on admission and perception of his/her improvement at the end of a rehabilitation process. The PAS was administered to 127 inpatients on admission to and at discharge from a rehabilitation program. All 127 inpatients, recruited in a prospective multicenter study, completed the rehabilitation program. The statistical analysis identified a total of 38 items to be retained in the PAS, out of an initial 82 items. The results provide evidence of the validity and reliability of the PAS in its final version.

The Scientific World Journal, 2015

The operational model and strategies developed at the Institute S. Anna-RAN to be applied in the ... more The operational model and strategies developed at the Institute S. Anna-RAN to be applied in the care and neurorehabilitation of subjects with disorders of consciousness (DOC) are described. The institute units are sequentially organized to guarantee appropriate care and provide rehabilitation programs adapted to the patients' clinical condition and individual's needs at each phase of evolution during treatment in a fast turnover rate. Patients eligible of home care are monitored remotely. Transferring advanced technology to a stage of regular operation is the main mission. Responsiveness and the time windows characterized by better residual responsiveness are identified and the spontaneous/induced changes in the autonomic system functional state and biological parameters are monitored both in dedicated sessions and by means of an ambient intelligence platform acquiring large databases from traditional and innovative sensors and interfaced with knowledge management and knowledge discovery systems. Diagnosis of vegetative state/unresponsive wakefulness syndrome or minimal conscious state and early prognosis are in accordance with the current criteria. Over one thousand patients with DOC have been admitted and treated in the years 1998-2013. The model application has progressively shortened the time of hospitalization and reduced costs at unchanged quality of services.

American Journal of Physical Medicine & Rehabilitation, 2015

Journal of neurotrauma, Jan 20, 2015

Diagnosis and early prognosis of the vegetative state/unresponsive wakefulness syndrome (VS/UWS) ... more Diagnosis and early prognosis of the vegetative state/unresponsive wakefulness syndrome (VS/UWS) and its differentiation from the minimally conscious state still rest on the clinical observation of responsiveness. The incidence of established clinical indicators of responsiveness has proven variable also in the single subject and correlated to measures of heart rate variability (HRV) describing the sympathetic/parasympathetic balance. We tested responsiveness when the HRV descriptors nuLF and peakLF were or were not in the ranges with highest incidence of response in previous studies (10-70 and 0.05-0.11 Hz, respectively). Testing was blind by CRS-r in the two conditions and in two experimental sessions at 1 wk. interval. The incidence of responses was not randomly distributed in the "response" and "no-response" conditions (McNemar test; p<0.0001). The observed incidence in the "response" condition was higher (visual: 55.1%; auditory: 51.5%) than pre...

Journal of Rehabilitation Medicine, 2009

Robot ARAMIS (Automatic Recovery Arm Motility Integrated System) is intended to provide the thera... more Robot ARAMIS (Automatic Recovery Arm Motility Integrated System) is intended to provide the therapist with novel and time/cost-efficient approaches to the rehabilitation of the paretic upper limb after stroke. The system has been designed and implemented based on common experience in rehabilitation and will provide a robot-patient interaction compensating for some intrinsic limitations of traditional treatments. Rationale, technical characteristics and application are described in detail here.

Journal of Rehabilitation Medicine, 2009

Journal of Psychophysiology, 2010

The vegetative state is characterized by the absence of awareness, voluntary or otherwise purpose... more The vegetative state is characterized by the absence of awareness, voluntary or otherwise purposeful behavioral responses to external stimuli, and communication in the severely brain damaged. It is thought to result from an anatomical/functional disconnection between the brainstem and cortex as a result of diffuse axonal damage/impairment. Early assistance/rehabilitation and the logistic and medical/paramedical resources made available in the 1990s

Journal of Neurotrauma, 2011

Visual pursuit is a key descriptor of the minimally conscious state (above 80% of cases). It is a... more Visual pursuit is a key descriptor of the minimally conscious state (above 80% of cases). It is also observable in about 20% of subjects in vegetative state. Its reappearance after severe brain damage anticipates a favorable outcome, with recovery of consciousness in 73% of subjects (45% in the absence of it). We considered retrospectively 395 subjects in vegetative state because of traumatic (63%), massive acute vascular (30%), or diffuse anoxic-hypoxic (7%) brain damage consecutively admitted to one dedicated unit during the years 1998-2008. Visual tracking was observed in 290 subjects (73.4%) and was already detectable within 50 days from brain injury in about 60% of post-traumatic or vascular subjects and 21% of anoxic-hypoxic patients. After 230 days of follow-up or more, it was observed in 89% and 88% of post-traumatic and vascular subjects and in 67% of anoxic-hypoxic patients. Rating with the Glasgow Outcome Scale (GOS) was better in those subjects with recovered visual tracking and inversely correlated with the time of reappearance in post-traumatic and vascular subjects; also the subjects with late recovery of eye tracking (230 days or more) had better GOS outcome than those without it. The observation of visual tracking reappearing in subjects in vegetative state would reflect recuperation of the brainstem-cortical interaction and overall brain functional organization that are thought to sustain consciousness and are interfered with by the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;functional disconnection,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; resulting in the vegetative state.

Biological Psychiatry, 2012

Atherosclerosis, 2006

According to the focal nature of atherosclerosis, ischemic stroke is frequently unilateral. Ather... more According to the focal nature of atherosclerosis, ischemic stroke is frequently unilateral. Atherosclerotic plaques are favoured by local hemodynamic factors as low wall shear stress and/or elevated circumferential wall tension. Aim of the present study was to investigate the possible association between hemodynamic forces and cerebrovascular disease. Common carotid mean wall shear stress and circumferential wall tension, Peterson's elastic modulus, and blood flow were measured in 25 patients with a recent unilateral large-artery stroke presenting non-stenotic plaques of the carotid arteries (large-artery group), and in 10 patients affected by a recent unilateral cardioembolic stroke without carotid plaques (cardioembolic group). In the large-artery group, atherosclerosis was slightly more evident in the side of cerebral ischemia. All hemodynamic factors were more unfavourable at the affected side in this group (shear stress: 6.2 ± 3.0 versus 8.6 ± 4.0 dynes/cm 2 , p < 0.0001; wall tension: (7.3 ± 1.3) × 10 4 versus (6.6 ± 1.3) × 10 4 dynes/cm, p < 0.00001; Peterson's modulus: (16.8 ± 11.9) × 10 5 versus (12.4 ± 5.7) × 10 5 dynes/cm 2 , p = 0.06). No difference was detectable in blood flow and in cardioembolic group. The present data demonstrate an unfavourable hemodynamic profile in the common carotid artery supplying the area of a single large-artery stroke and might help to explain the frequent one-sidedness of this disease.

Journal of Rehabilitation Medicine, 2009

BMC Neurology, 2015

Background: Despite evidence from neuroimaging research, diagnosis and early prognosis in the veg... more Background: Despite evidence from neuroimaging research, diagnosis and early prognosis in the vegetative (VS/UWS) and minimally conscious (MCS) states still depend on the observation of clinical signs of responsiveness. Multiple testing has documented a systematic variability during the day in the incidence of established signs of responsiveness. Spontaneous fluctuations of the Coma Recovery Scale-revised (CRS-r) scores are conceivable. Methods: We retrospectively analyzed the CRS-r repeatedly administered to 7 VS/UWS and 12 MCS subjects undergoing systematic observation during a conventional 13 weeks. rehabilitation plan. Results: The CRS-r global, visual and auditory scores were found higher in the morning than at the afternoon administration in both VS/UWS and MCS subgroups over the entire period of observation. The probability for a VS/UWS subject of being classified as MCS at the morning testing at least once during the 13 weeks. observation was as high as 30 %, i.e., compatible with the reported misdiagnosis rate between the two clinical conditions. Conclusions: Multiple CRS-r testing is advisable to minimize the risk of misclassification; estimates of spontaneous variability could be used to characterize with greater accuracy patients with disorder of consciousness and possibly help optimize the rehabilitation plan.

Brain Injury, 2020

Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (... more Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state-MCS) and in different etiologies.. Design: Multi-center cross-sectional observational study. Setting: 23 intensive neurorehabilitation units. Subjects: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury. Main Measures: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications. Results: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology. Conclusion: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.

European Journal of Physical and Rehabilitation Medicine, 2020

This paper reports the immediate impact of the epidemic on rehabilitation services in Italy, the ... more This paper reports the immediate impact of the epidemic on rehabilitation services in Italy, the first country in Europe hit by Covid-19. In a country with almost 5,000 Physical and Rehabilitation Medicine physicians, the webinar had 230 live viewers (4.5%), and more than 8,900 individual visualizations of the recorded version. The overall inadequate preparation of the rehabilitation system to face a sudden epidemic was clear, and similar to that of the acute services. The original idea of confining the Covid-19 cases to some areas of rehabilitation wards and/or hospitals, preserving others, proved not to be feasible. Continuous reorganization and adaptation were required due to the rapid changes. Overall, rehabilitation needs had to surrender to the more acute emergency, with total conversion of beds, wards and even hospitals. The quarantine needs heavily involved also outpatient services that were mostly closed. Rehabilitation professionals needed support, but also acted properly, again similarly to what happened in the acute wards. The typical needs of rehabilitation, such as human and physical contacts, but also social interactions including patient, team, family and caregivers, appeared clearly in the current unavoidable need of being suppressed. These notes could serve the preparation of other services worldwide.

Journal of Neurotrauma, 2019

The rate of paroxysmal sympathetic hyperactivity (PSH) was retrospectively assessed using the Par... more The rate of paroxysmal sympathetic hyperactivity (PSH) was retrospectively assessed using the Paroxysmal Sympathetic Hyperactivity-Assessment Measure (PSH-AM) scale in patients with disorders of consciousness attributed to traumatic and non-traumatic acquired brain injury during the rehabilitation phase. These results were compared with previous studies carried out in the same clinical scenario, in order to verify the prevalence of PSH signs from 1998 to 2014. The entire sample consisted of 140 patients in vegetative state/unresponsive wakefulness syndrome or minimally conscious state admitted to a neurorehabilitation subacute unit from June 2010 to December 2014. PSH-AM revealed the presence of PSH in 16% of traumatic and 12% of non-traumatic younger patients. In the non-traumatic group, the rate was higher in patients with anoxia-hypoxia (37.5%) etiology than those with vascular brain injury (6.7%). A comparison with previous studies revealed a reduction in the number of PSH cases in traumatic patients. This study provides evidence that PSH-AM can be used prospectively to detect the rate of PSH and stratify severity of signs. Further longitudinal analysis is warranted to confirm the prevalence of PSH signs in non-traumatic brain injured patients.

Biomedicines, 2022

One of the main challenges in traumatic brain injury (TBI) patients is to achieve an early and de... more One of the main challenges in traumatic brain injury (TBI) patients is to achieve an early and definite prognosis. Despite the recent development of algorithms based on artificial intelligence for the identification of these prognostic factors relevant for clinical practice, the literature lacks a rigorous comparison among classical regression and machine learning (ML) models. This study aims at providing this comparison on a sample of TBI patients evaluated at baseline (T0), after 3 months from the event (T1), and at discharge (T2). A Classical Linear Regression Model (LM) was compared with independent performances of Support Vector Machine (SVM), k-Nearest Neighbors (k-NN), Naïve Bayes (NB) and Decision Tree (DT) algorithms, together with an ensemble ML approach. The accuracy was similar among LM and ML algorithms on the analyzed sample when two classes of outcome (Positive vs. Negative) approach was used, whereas the NB algorithm showed the worst performance. This study highlight...

ARAMIS (Automatic Recovery Arm Motility Integrated System) is a dual exoskeleton robot, intended ... more ARAMIS (Automatic Recovery Arm Motility Integrated System) is a dual exoskeleton robot, intended to provide the therapist with novel and time/cost efficient approach to the rehabilitation of the paretic upper limb after stroke. The system has been developed in order to enable therapists to define and apply patient-specific rehabilitation exercises with multidisciplinary support by neurologist, engineers, ICT specialists and designers. ARAMIS allows three main strategies: 1) Asynchronous Exercise 2) Synchronous Exercise and 3) Virtual Exercise. This paper reports preliminary results from a patients' sample trained by ARAMIS.

Functional neurology

The aim of this study was to validate the Progression of Autonomies Scale (PAS) for the evaluatio... more The aim of this study was to validate the Progression of Autonomies Scale (PAS) for the evaluation of autonomies in severe acquired brain injury patients. The PAS design is based on a model of progressive recovery of autonomies and is organized in three domains (Personal, Domestic and Extra-domestic). Scores assigned range from zero to three. The PAS items gather information about the patient's perception and awareness of his/her disability(ies) on admission and perception of his/her improvement at the end of a rehabilitation process. The PAS was administered to 127 inpatients on admission to and at discharge from a rehabilitation program. All 127 inpatients, recruited in a prospective multicenter study, completed the rehabilitation program. The statistical analysis identified a total of 38 items to be retained in the PAS, out of an initial 82 items. The results provide evidence of the validity and reliability of the PAS in its final version.

The Scientific World Journal, 2015

The operational model and strategies developed at the Institute S. Anna-RAN to be applied in the ... more The operational model and strategies developed at the Institute S. Anna-RAN to be applied in the care and neurorehabilitation of subjects with disorders of consciousness (DOC) are described. The institute units are sequentially organized to guarantee appropriate care and provide rehabilitation programs adapted to the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; clinical condition and individual&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s needs at each phase of evolution during treatment in a fast turnover rate. Patients eligible of home care are monitored remotely. Transferring advanced technology to a stage of regular operation is the main mission. Responsiveness and the time windows characterized by better residual responsiveness are identified and the spontaneous/induced changes in the autonomic system functional state and biological parameters are monitored both in dedicated sessions and by means of an ambient intelligence platform acquiring large databases from traditional and innovative sensors and interfaced with knowledge management and knowledge discovery systems. Diagnosis of vegetative state/unresponsive wakefulness syndrome or minimal conscious state and early prognosis are in accordance with the current criteria. Over one thousand patients with DOC have been admitted and treated in the years 1998-2013. The model application has progressively shortened the time of hospitalization and reduced costs at unchanged quality of services.

American Journal of Physical Medicine & Rehabilitation, 2015

Journal of neurotrauma, Jan 20, 2015

Diagnosis and early prognosis of the vegetative state/unresponsive wakefulness syndrome (VS/UWS) ... more Diagnosis and early prognosis of the vegetative state/unresponsive wakefulness syndrome (VS/UWS) and its differentiation from the minimally conscious state still rest on the clinical observation of responsiveness. The incidence of established clinical indicators of responsiveness has proven variable also in the single subject and correlated to measures of heart rate variability (HRV) describing the sympathetic/parasympathetic balance. We tested responsiveness when the HRV descriptors nuLF and peakLF were or were not in the ranges with highest incidence of response in previous studies (10-70 and 0.05-0.11 Hz, respectively). Testing was blind by CRS-r in the two conditions and in two experimental sessions at 1 wk. interval. The incidence of responses was not randomly distributed in the "response" and "no-response" conditions (McNemar test; p<0.0001). The observed incidence in the "response" condition was higher (visual: 55.1%; auditory: 51.5%) than pre...

Journal of Rehabilitation Medicine, 2009

Robot ARAMIS (Automatic Recovery Arm Motility Integrated System) is intended to provide the thera... more Robot ARAMIS (Automatic Recovery Arm Motility Integrated System) is intended to provide the therapist with novel and time/cost-efficient approaches to the rehabilitation of the paretic upper limb after stroke. The system has been designed and implemented based on common experience in rehabilitation and will provide a robot-patient interaction compensating for some intrinsic limitations of traditional treatments. Rationale, technical characteristics and application are described in detail here.

Journal of Rehabilitation Medicine, 2009

Journal of Psychophysiology, 2010

The vegetative state is characterized by the absence of awareness, voluntary or otherwise purpose... more The vegetative state is characterized by the absence of awareness, voluntary or otherwise purposeful behavioral responses to external stimuli, and communication in the severely brain damaged. It is thought to result from an anatomical/functional disconnection between the brainstem and cortex as a result of diffuse axonal damage/impairment. Early assistance/rehabilitation and the logistic and medical/paramedical resources made available in the 1990s

Journal of Neurotrauma, 2011

Visual pursuit is a key descriptor of the minimally conscious state (above 80% of cases). It is a... more Visual pursuit is a key descriptor of the minimally conscious state (above 80% of cases). It is also observable in about 20% of subjects in vegetative state. Its reappearance after severe brain damage anticipates a favorable outcome, with recovery of consciousness in 73% of subjects (45% in the absence of it). We considered retrospectively 395 subjects in vegetative state because of traumatic (63%), massive acute vascular (30%), or diffuse anoxic-hypoxic (7%) brain damage consecutively admitted to one dedicated unit during the years 1998-2008. Visual tracking was observed in 290 subjects (73.4%) and was already detectable within 50 days from brain injury in about 60% of post-traumatic or vascular subjects and 21% of anoxic-hypoxic patients. After 230 days of follow-up or more, it was observed in 89% and 88% of post-traumatic and vascular subjects and in 67% of anoxic-hypoxic patients. Rating with the Glasgow Outcome Scale (GOS) was better in those subjects with recovered visual tracking and inversely correlated with the time of reappearance in post-traumatic and vascular subjects; also the subjects with late recovery of eye tracking (230 days or more) had better GOS outcome than those without it. The observation of visual tracking reappearing in subjects in vegetative state would reflect recuperation of the brainstem-cortical interaction and overall brain functional organization that are thought to sustain consciousness and are interfered with by the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;functional disconnection,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; resulting in the vegetative state.

Biological Psychiatry, 2012

Atherosclerosis, 2006

According to the focal nature of atherosclerosis, ischemic stroke is frequently unilateral. Ather... more According to the focal nature of atherosclerosis, ischemic stroke is frequently unilateral. Atherosclerotic plaques are favoured by local hemodynamic factors as low wall shear stress and/or elevated circumferential wall tension. Aim of the present study was to investigate the possible association between hemodynamic forces and cerebrovascular disease. Common carotid mean wall shear stress and circumferential wall tension, Peterson's elastic modulus, and blood flow were measured in 25 patients with a recent unilateral large-artery stroke presenting non-stenotic plaques of the carotid arteries (large-artery group), and in 10 patients affected by a recent unilateral cardioembolic stroke without carotid plaques (cardioembolic group). In the large-artery group, atherosclerosis was slightly more evident in the side of cerebral ischemia. All hemodynamic factors were more unfavourable at the affected side in this group (shear stress: 6.2 ± 3.0 versus 8.6 ± 4.0 dynes/cm 2 , p < 0.0001; wall tension: (7.3 ± 1.3) × 10 4 versus (6.6 ± 1.3) × 10 4 dynes/cm, p < 0.00001; Peterson's modulus: (16.8 ± 11.9) × 10 5 versus (12.4 ± 5.7) × 10 5 dynes/cm 2 , p = 0.06). No difference was detectable in blood flow and in cardioembolic group. The present data demonstrate an unfavourable hemodynamic profile in the common carotid artery supplying the area of a single large-artery stroke and might help to explain the frequent one-sidedness of this disease.

Journal of Rehabilitation Medicine, 2009