Augmentative and Alternative Communication as an Ecological Window on Neglect-Related Spatial Asymmetry After Hemorrhagic Stroke: A Longitudinal Case Report Carmela Rifici, Rosaria De Luca, Francesco Corallo, Sabrina Miceli, Santina Caliri, et al. Brain Sciences, 2026 Background/Objectives: Spatial neglect after stroke may be difficult to characterize in patients with severe motor, cognitive, and communication impairment. Augmentative and alternative communication interfaces require visual scanning and intentional selection and may therefore provide an ecological context in which lateralized visuospatial behavior becomes clinically observable. Methods: A 58-year-old man with a unilateral right-hemisphere hemorrhagic stroke underwent serial assessment at baseline before training, at the end of 24 AAC sessions delivered over 2 months in addition to standard neurorehabilitation, and at 1-month follow-up. Measures included cognitive functioning, behavioral responsiveness, global disability, bedside communication status, and P300 latency. The AAC/eye-tracking intervention also generated process data across 21 analyzable sessions, including calibration quality, free-exploration heatmaps, and performance in the Stars and Bow-Target tasks. Results: Global measures showed modest early improvement followed by stabilization. Cognitive functioning improved from 2 to 3 and remained stable, behavioral responsiveness increased from 7 to 10 and then to 11, bedside communication increased from 7 to 9 and remained stable, and P300 latency decreased from 393 to 350 and then to 351 ms, whereas global disability remained unchanged at 25 throughout. Calibration was at least good in all quadrants and never scored 0. Performance was lower and more unstable in Stars than in Bow-Target. Heatmaps showed rightward clustering, reduced left-sided exploration, and limited whole-screen scanning. Conclusions: AAC/eye-tracking did not provide formal diagnostic proof of neglect, but it supported ecological recognition of a neglect-like lateralized exploratory pattern under less guided conditions.
Aquatic Therapy as a Programmable Multisensory Environment for Arousal and Postural Control After Severe Acquired Brain Injury: A Perspective Andrea Calderone, Rosaria De Luca, Alessio Currò, Alessio Mirabile, Marco Piccione, et al. Brain Sciences, 2026 Background/Objectives: Severe acquired brain injury (sABI) disrupts early rehabilitation because arousal fluctuates, trunk control is fragile, and agitation limits therapy tolerance; land-based practice is frequently constrained by fall risk and staffing. We aim to reframe aquatic therapy as a programmable multisensory environment to stabilize arousal and support axial alignment before conventional impairment targets are feasible. Here, programmable denotes the deliberate titration and reporting of water depth, turbulence or perturbation, temperature, body orientation, and flotation and manual support as intervention inputs. Methods: This perspective integrates principles from neurobehavioral assessment, motor control, and immersion physiology to propose the Arousal–Alignment–Action loop as a falsifiable model and to define manipulable aquatic inputs (water depth, turbulence or perturbation, temperature, body orientation, and flotation and manual support) as dosing parameters. We outline a pragmatic testing ladder (within-session micro-experiments, feasibility studies, and embedded evaluations) and a minimal outcomes and confounder set to support cumulative evidence. Results: The framework links state regulation to alignment and goal-directed behavior, specifies predictions that can fail, and highlights boundary conditions (sedation, autonomic instability, pain, recent surgery or wounds, and cervical or cardiopulmonary constraints). A minimal outcome package spanning arousal/responsiveness, trunk control, behavioral dysregulation, participation/tolerance, and basic physiology is proposed, with optional objective adjuncts for mechanism-oriented studies. Conclusions: Treating water as a measurable and titratable medium, rather than a generic modality, may reduce early intensity bottlenecks and improve implementability and comparability of aquatic neurorehabilitation research in medically stable sABI; however, the model is intended as hypothesis-generating until supported by stronger direct clinical evidence.
Targeting Cognition and Behavior Post-Stroke: Combined Emotional Music Stimulation and Virtual Attention Training in a Quasi-Randomized Study Rosaria De Luca, Federica Impellizzeri, Francesco Corallo, Andrea Calderone, Rosalia Calapai, et al. Brain Sciences, 2025 Background: Emotionally salient music may enhance attention-focused rehabilitation, yet concurrent music plus virtual-reality programs in chronic stroke are largely untested. We assessed whether personalized emotional music stimulation (EMS) layered onto a standardized virtual reality rehabilitation system (VRRS) augments cognitive, affective, physiological, and functional outcomes. Methods: In a quasi-randomized outpatient trial, 20 adults ≥ 6 months post-ischemic stroke were allocated by order of recruitment to VRRS alone (control, n = 10) or VRRS+EMS (experimental, n = 10). Both groups performed 45 min of active VRRS cognitive training (3×/week, 8 weeks), while the EMS group received approximately 60 min sessions including setup and feedback phases. Primary outcomes were cognition and global function; secondary outcomes were intrinsic motivation, depression, anxiety, and heart rate. Non-parametric tests with effect sizes and Δ-scores were used. Results: The experimental group improved across all domains: cognition (median +4.5 points), motivation (median +54 points), depression (median −3.5 points), anxiety (median −4.0 points), heart rate (median −6.35 beats per minute), and disability (median one-grade improvement), each with large effects. The control group showed smaller gains in cognition and motivation and a modest heart-rate reduction, without significant changes in mood or disability. At post-treatment, the music group outperformed controls on cognition, motivation, and disability. Change-score analyses favored the music group for every endpoint. Larger heart-rate reductions correlated with greater improvements in depression (ρ = 0.73, p < 0.001) and anxiety (ρ = 0.58, p = 0.007). Conclusions: Adding personalized emotional music to virtual-reality attention training produced coherent, clinically relevant gains in cognition, mood, motivation, autonomic regulation, and independence compared with virtual reality alone.
Predictive Factors of Successful Decannulation in Tracheostomy Patients: A Scoping Review Andrea Calderone, Serena Filoni, Rosaria De Luca, Francesco Corallo, Rosalia Calapai, et al. Journal of Clinical Medicine, 2025 Background/Objective: Tracheostomy (TCT) creates an artificial airway, essential for overcoming obstructions or enabling long-term ventilation. Decannulation represents a critical step in recovery, with its success strongly influenced by the underlying indication for tracheostomy and the patient’s clinical profile. Successful decannulation requires careful assessment of multiple factors, including respiratory function and underlying pathology. This scoping review aims to identify and categorize these predictive factors, crucial for optimizing decannulation protocols and patient outcomes. Methods: A scoping review was conducted using the PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, and Scopus databases (22 February 2025–3 March 2025) to identify studies regarding predictors of successful decannulation. Studies examining physiological, clinical, and demographic factors associated with decannulation outcomes were included. Data were extracted using a standardized form and synthesized narratively. Results: Fifty studies reported a male representation averaging 67% of the total patient population, comprising 2238 males and 1281 females aged 50–70 with acquired brain injuries, employing retrospective and prospective designs. Positive decannulation outcomes correlate with strong cough, effective secretion management, younger age, and robust neurological status. Adverse events were generally mild, with recannulation being infrequent. Conversely, advanced age, chronic lung disease, a high body mass index, and prolonged mechanical ventilation negatively influence decannulation success. Conclusions: It was highlighted that successful decannulation is the result of various physiological, clinical, and demographic factors. Significantly, strong respiratory function, demonstrated by powerful cough reflexes and efficient secretion control, stands out as a fundamental predictive factor.
The Role of Empathy in ADHD Children: Neuropsychological Assessment and Possible Rehabilitation Suggestions—A Narrative Review Antony Casula, Giulia Belluardo, Carmine Antenucci, Federica Bianca, Francesco Corallo, et al. Medicina Lithuania, 2025 Background and Objectives: Theory of mind (ToM) deficits in children with ADHD are closely related to social difficulties and problems in interpersonal interactions. Evidence suggests that these cognitive deficits negatively affect the ability to understand and respond to others’ emotions and intentions, thus contributing to social isolation and a lower quality of life. However, the findings across studies vary, indicating that ADHD subtype and comorbidities, such as anxiety and mood disorders, can significantly influence sociocognitive deficits, modulating the extent of social problems. Materials and Methods: This review examines the relationship among ADHD, ToM, and empathy, analyzing studies comparing children with ADHD with peers with typical development or other neurodevelopmental conditions. A search in PubMed, Scopus, and the Cochrane Library prior to January 10, without time restrictions, using “ADHD”, “Cognitive Empathy”, and “Theory of Mind” identified relevant studies assessing these abilities through neuropsychological tests or questionnaires. Results: Of the initial 243 studies, 23 studies met the inclusion criteria. Children with ADHD exhibited significant impairments in ToM and empathy, affecting social cognition and interpersonal understanding. Various assessment tools revealed difficulties in understanding beliefs, emotions, and intentions, with executive function deficits playing a crucial role in shaping these social challenges. Conclusions: This review highlights the need for targeted therapeutic interventions that not only address cognitive deficits but consider emotional and metacognitive aspects, such as emotion regulation and self-awareness. Future research should focus on integrating executive function training with approaches that develop metacognitive and emotional skills, thus providing more comprehensive support.
Beauty in the shadow of neurodegenerative disease: a narrative review on aesthetic experience, neural mechanisms, and therapeutic frontiers Andrea Calderone, Rosaria De Luca, Rosalia Calapai, Alessio Mirabile, Angelo Quartarone, et al. Frontiers in Human Neuroscience, 2025 Neuroaesthetics, an emerging field at the intersection of neuroscience, psychology, and the arts, offers new perspectives on the biological and cognitive mechanisms of aesthetic experience. This narrative review explores the convergence of neuroaesthetics and neurodegenerative disorders, focusing on Alzheimer’s disease, Parkinson’s disease, frontotemporal dementia, and Huntington’s disease. Drawing on evidence from neuroimaging, neuropsychology, and clinical studies, we examine how neurodegenerative processes differentially disrupt the neural systems of the “aesthetic triad”: sensory-motor, emotion-valuation, and meaning-knowledge. Such disruptions not only impair patients’ ability to perceive and create art but may also reveal unexpected creative capacities. We discuss the therapeutic potential of arts-based interventions, highlighting the benefits of personalized and technology-driven approaches, including immersive virtual reality and digital art platforms, to enhance neurorehabilitation and psychological wellbeing. The “Michelangelo effect,” where engagement in meaningful aesthetic activities supports learning, motivation, and resilience, exemplifies this translational potential. Our synthesis underscores clinical, neuroscientific, and rehabilitative implications, while noting ongoing challenges such as the need for standardized outcomes and interdisciplinary collaboration. Integrating neuroaesthetic principles into neurorehabilitation may help preserve cognitive and motor functions and enrich quality of life and self-concept in people with neurodegenerative disease. Future research should optimize these approaches to ensure meaningful benefits for patients.
Correlation of cognitive dysfunctions and diffusion tensor MRI measures in subjects with RRMS Alessio Mirabile, Carla Susinna, Giovanni Luca Cipriano, Giangaetano D’Aleo, Carmela Rifici, et al. Frontiers in Aging Neuroscience, 2025 Background Cognitive dysfunction is a common impairment observed in individuals with Multiple Sclerosis (MS), affecting key domains such as attention, information processing speed, memory, and executive functions. This deficit is typically identified through comprehensive neuropsychological assessments, which represent the gold standard for cognitive evaluation. In recent years, increasing efforts have been made to integrate neuropsychological findings with advanced neuroimaging techniques to better understand the neural substrates of cognitive dysfunction. Among these, Diffusion Tensor Imaging (DTI) has emerged as a valuable tool for investigating microstructural changes in white matter (WM) that may underlie cognitive deficits in MS. However, despite its clinical utility, the pathophysiological mechanisms contributing to cognitive impairment, particularly in subjects with Relapsing–Remitting MS (RRMS), remain complex and not yet fully understood. This review focuses on studies investigating WM alterations measured by DTI and their correlation with cognitive dysfunction as assessed through neuropsychological testing. Method Papers were identified by searching in PubMed, Embase, Web of Science and Scopus databases from 2002 - the years, of first related published article, − to December 2024. From the initial 853, we included only 34 studies that met to eligibility criteria. Results In subjects with RRMS, WM alterations, assessed through DTI, were found to correlate with cognitive dysfunction, as measured by standardized neuropsychological tests. These alterations were observed both in global WM and in specific regions, including the corpus callosum, thalamus, hippocampus, cerebellar structure, cingulum, and cerebral fascicles. Conclusion These findings underscore the relevance of integrating neuropsychological assessment with advanced neuroimaging techniques, such as DTI, to enhance our understanding of cognitive impairment in RRMS. DTI-derived measures of WM integrity show promise as potential biomarkers of cognitive dysfunction, while cognitive profiling can help localize underlying neuropsychological damage. This integrated approach may improve early detection of cognitive alterations and support the development of targeted therapeutic strategies aimed at preserving cognitive functioning in individuals with MS. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251073195 , Identifier CRD420251073195.
