Intensive-Care-Unit-Acquired Weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients and can have a significant impact on long-term disability. Early rehabilitation has been suggested to facilitate the natural recovery process. This is a pilot, randomized, single-blind study that aimed to evaluate the effectiveness of intensive combined technological rehabilitation treatment including focal muscle vibration and non-immersive virtual reality for patients with severe acquired brain injury (sABI) and ICU-AW. Twenty-four patients were randomized into the conventional group, which performed only conventional rehabilitation, and the experimental group, which also performed technological treatment. At baseline and after 3 weeks of treatment, assessments of motor function, autonomy, disability and quality of life were conducted. At the end of the intervention, both groups showed significant improvements. However, patients in the experimental group achieved greater improvements in disability (p = 0.001) and quality of life (p = 0.001). The results show that intensive structured rehabilitation is effective in improving the motor function, disability and quality of life of patients with severe acquired brain injury and acquired weakness. The combination of non-immersive virtual reality training and focal muscle vibration can result in a significant improvement in overall disability and quality of life compared with conventional treatment alone.

A subgroup of COVID-19 patients requires intensive respiratory care. The prolonged immobilization and aggressive treatments predispose these patients to develop intensive care unit-acquired weakness (ICUAW). Furthermore, this condition could increase the chance of positioning-related peripheral nerve injuries. On the basis of the latest literature review, we describe a case series of three patients with COVID-19 who developed ICUAW complicated by positioning-related peripheral nerve injuries Every patient presented sensorimotor axonal polyneuropathy and concomitant myopathy in electrophysiological studies. Furthermore, muscle MRI helped the diagnosis of ICUAW, showing massive damage predominantly in the proximal muscles. Notably, nerve ultrasound detected positioning-related peripheral nerve injuries, even though the concomitant ICUAW substantially masked their clinical features. During the acute phase of severe COVID-19 infection, most medical attention tends to be assigned to critical care management, and neuromuscular complications such as ICUAW and positioning-related peripheral nerve injuries could be underestimated. Hence, when starting post-ICU care for COVID-19 cases, the combination of electrophysiological and imaging studies will aid appropriate evaluation on the patients with COVID-19-related ICUAW.

(1) Background: Parsonage–Turner Syndrome (PTS) is a rare peripheral nerve disease characterized by different degrees of nerve impairment. The recent development of nerve ultrasound has enabled the use of new data in the diagnosis of the disease. The aim of this study is to conduct a literature review about the ultrasound evaluation of PTS and present two clinical cases that are characteristic of the disease. (2) Methods: A review of the literature from the last 10 years on the topic containing data regarding nerve ultrasound was performed. In addition, two cases of patients on whom nerve ultrasound was performed at the first evaluation and at follow-up after the indicated treatment were described. (3) Results: The results of our review show that although it is defined as plexopathy, PTS is most often a form of multifocal neuropathy. We also report the most frequently used ultrasound classification and possible prognostic correlations and report our experience with the description of two paradigmatic clinical cases. (4) Conclusions: Further studies are needed to understand the true prognostic power of each degree of nerve impairment and the possible implications in clinical practice regarding treatment indications.

Frailty is characterized by increased vulnerability, which impairs the ability to cope with stressors and represents a risk factor for the development of disability. Moreover, the population of older adults is continuously increasing. For this reason, frailty and aging represent very important social and health topics. The management of elderly patients, especially when they are hospitalized, is complex and requires the collaboration of multiple professionals and different approaches to intervene in the multi-morbidity that characterizes this population. A significant percentage of hospitalized older patients present several comorbidities that cause prolonged hospital stays. This condition could lead to clinical complications, increased costs of care, and a higher likelihood of in-hospital death. Aging is a concept that encompasses several symptoms and requires a multidisciplinary and specific approach, especially during hospitalization and in acute care settings. The present study aims to evaluate how intensive rehabilitation treatment is accompanied by improvement in some hematological and clinical parameters and could contribute to an evolution in disability among elderly patients. The results of the present research show the crucial role of rehabilitation treatment in the development of disability, independence, and self-sufficiency in a population of older inpatients in a post-acute care setting. Further research should be conducted to identify other biomarkers useful in the management of frail patients.

Background: Alterations in corticospinal and intracortical excitability are frequently observed following a stroke. Cortical plasticity and reorganization after stroke can be assessed using transcranial magnetic stimulation (TMS) measures. These include Motor Threshold (MT) and Motor Evoked Potential (MEP) obtained from single-pulse TMS and Short-Interval Intracortical inhibition (SICI) and Intracortical Facilitation (ICF) obtained from Paired-Pulse Paradigms (ppTMS). Objective: This narrative review aims to provide an update on the most relevant studies and clinically interpret alterations in excitability measures from ppTMS studies following a stroke, focusing on the effects of stroke on MT, MEP, SICI, and ICF in both hemispheres. Additionally, we analyze intracortical disinhibition across different stages of recovery and the implications for inter-hemispheric competition during recovery. Literature search strategy: Studies investigating corticospinal excitability and intracortical inhibition/facilitation after stroke using ppTMS paradigms were reviewed. The main neurophysiological outcomes included MT, MEP amplitude, SICI, and ICF, comparing the affected and unaffected hemispheres and healthy controls. Results: The reviewed literature consistently demonstrates reduced corticospinal excitability in the affected hemisphere, characterized by an increased MT and decreased MEP amplitude. Conversely, intracortical inhibitory and facilitatory circuits appear to be altered after stroke. Reduced SICI and modified ICF patterns suggest cortical disinhibition. Conclusions: Assessments based on ppTMS can be considered significant indicators of post-stroke cortical reorganization. Cortical motor inhibition may have an adaptable or stage-specific role, potentially beneficial in the acute and subacute stages, but harmful if it continues beyond the chronic phase.

Background: Spasticity significantly impairs functional recovery after severe acquired brain injury. Current management methods predominantly rely on pharmacological interventions, which can cause substantial side effects or require invasive medical procedures in refractory cases. Focal muscle vibration, a noninvasive technique that applies mechanical vibrations to muscle–tendon units and alters spinal and cortical excitability via proprioceptive pathways, has been effective in reducing spasticity in subjects with stroke. However, there is limited data to support focal muscle vibration as a viable option for improving functional recovery in patients with severe acquired brain injury. Objectives: To evaluate the clinical effects of adding focal muscle vibration to standard physiotherapy compared with standard physiotherapy alone in patients with severe acquired brain injury and spastic hypertonia. Methods: Twenty-four patients were randomly assigned to receive focal muscle vibration in addition to standard care (n = 12) or standard care alone (n = 12) for 3 weeks. Assessments were conducted at baseline, immediately after physiotherapy, and 3 weeks after physiotherapy. The outcomes assessed included the Modified Ashworth Scale, Disability Rating Scale, Modified Barthel Index, and three pain measures. Results: A significant reduction in spasticity was observed in the focal muscle vibration group, as indicated by the Modified Ashworth Scale scores (p = 0.014). Disability Rating Scale scores demonstrated a statistically significant decrease in disability ratings at the end of treatment (p = 0.002) and during the follow-up phase (p = 0.002). Between-group comparisons of change scores revealed a statistically significant improvement in disability ratings in the focal muscle vibration group during the treatment phase (p = 0.011). Significant functional gains were noted on the Disability Rating Scale, which persisted at the follow-up evaluation. Conclusions: Focal muscle vibration reduces muscle spasticity and improves functional status in patients with severe acquired brain injury during inpatient rehabilitation. Future studies with larger sample sizes, blinded assessments, and stratified randomization are needed to verify these findings and develop standardized treatment protocols for this underserved population.