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.

Daily activities require balance and control posture. A severe Acquired Brain Injury (sABI) disrupts movement organization, control and execution, affecting trunk control and balance. Trunk control therapy for difficult patients requires known and novel methods. This study analyzes how hunova^® robotic platform therapy affects sABI patients’ sitting balance and trunk control. Twenty-six sABI patients were randomized into the experimental group (HuG) that employed hunova^® for trunk control in addition to traditional therapy and the control group (CoG) that received only conventional rehabilitation. Clinical assessments were performed for trunk, balance, cognitive and motor performance, disability, autonomy, quality of life, and fatigue. Both static and dynamic sitting balance and trunk control were assessed with hunova^®. HuG and CoG were significant in intragroup analysis. Intergroup comparisons showed substantial differences in trunk control, affected side motor function, autonomy, quality of life, and fatigue. Only patients with HuG improved statistically in the instrumental assessment of trunk control and sitting balance. Between-group analysis showed that a statistically significant difference emerged in COP path and trunk movement. The study found effectiveness and adaptability of hunova^® for trunk control rehabilitation, showing improvement in static and dynamic trunk control, motor function, autonomy, quality of life and fatigue in sABI patients. Registration: NCT05280587.

In this study, we aimed to assess the effects of transcranial direct current stimulation (tDCS) stimulation on brain metabolism in a patient with typical hemorrhagic stroke in a subacute phase. The patient was evaluated with ¹⁸F-FDG PET (18F-fluoro-2-deoxy-D-glucose positron emission tomography) during tDCS brain stimulation at 6, 8, and 10 weeks from the event. The patient underwent the following protocol: baseline cerebral ¹⁸F-FDG-PET (T0); cerebral ¹⁸F-FDG-PET during anodal-tDCS on the affected hemisphere (T1); and cerebral ¹⁸F-FDG-PET during cathodal-tDCS on the unaffected hemisphere (T2). Baseline PET examination revealed marked hypometabolism of the right nucleo-capsular hemorrhagic lesion; at T1, an increase in brain metabolism was shown in the stimulated hemisphere and unexpectedly in the non-stimulated hemisphere; at T2, a reduction in metabolism was documented in the hemisphere ipsilateral to the inhibiting current applied by tDCS. The use of PET may provide new insights into the effects of tDCS on brain metabolism, providing in vivo information about the plasticity mechanisms of the injured brain. Further studies, using a combination of PET and tDCS, are necessary to further clarify the mechanisms of action of this stimulation technique to the clinical and functional outcomes.

This review examines the effectiveness of integrating botulinum toxin type A (BONT-A) with various rehabilitative strategies in treating spastic diplegia in children. The studies analyzed consistently demonstrate significant reductions in spasticity and improvements in gait when BONT-A is combined with interventions such as intensive physical therapy, serial casting, electrical stimulation, physiotherapy, occupational therapy, and robotic-assisted gait training. The findings underscore the importance of personalized rehabilitation plans tailored to each child's needs. Early intervention is particularly effective in preventing spasticity and related complications, leading to better long-term outcomes. Despite the robust results, limitations such as heterogeneity in rehabilitative approaches, small sample sizes, and varying follow-up durations necessitate further research. Future studies should focus on larger, multicenter randomized controlled trials with standardized outcome measures and more extended follow-up periods to validate these findings and assess the long-term sustainability of treatment benefits. The review highlights the necessity of interdisciplinary collaboration among healthcare professionals to ensure comprehensive care, which is crucial for optimizing therapeutic outcomes. The consistent improvements in both spasticity reduction and gait functionality emphasize the critical role of integrated treatment approaches in enhancing the quality of life for pediatric patients with cerebral palsy. The evidence supports the implementation of comprehensive, personalized rehabilitation strategies in clinical practice, promoting early and proactive management to achieve the best possible outcomes for children with spastic diplegia. This review provides a foundation for developing best practices and guiding future research in pediatric neurorehabilitation.

Background and Clinical Significance Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin malignancy. Early diagnosis is essential to optimize therapeutic strategies and improve prognosis. However, the role of high-frequency ultrasound (HFUS) in the diagnostic and follow-up phases of MCC remains under-investigated and underutilized in clinical practice. Case Presentation We present a case of MCC initially referred to a physiatric outpatient clinic for a functional disorder of the third finger, where HFUS revealed a well-circumscribed, hypoechoic subdermal lesion with central and peripheral vascularity. Surgical excision, histopathology, and immunohistochemistry confirmed the diagnosis of Merkel cell carcinoma. The HFUS findings were correlated with histological features, and a structured sonographic follow-up protocol was established postoperatively. Conclusions This case highlights the diagnostic and prognostic potential of HFUS in MCC, especially in early detection, surgical planning, and longitudinal follow-up. A multidisciplinary approach integrating ultrasound imaging, surgery, and pathology may enhance diagnostic accuracy and patient management.

Background: Diastasis rectus abdominis is a condition in which the rectus abdominis muscles separate and move laterally, causing stretching of the linea alba tissue with weakness of the abdominal wall. Although it can lead to hernia of the abdominal viscera, diastasis rectus abdominis is not a hernia in itself. This condition is common among women during pregnancy and the postpartum period and can significantly affect their quality of life and their return to sports activity. Unfortunately, information on the incidence, risk factors, prevention, and treatment of diastasis rectus abdominis are limited. Methods: We conducted a pilot prospective observational study on 37 patients who practiced sports at high levels (at least 3 times a week with amateur/competitive competitions) who underwent ultrasound measurements of the distance between the rectus abdominis muscles at the level of the xiphoid process, supraumbilical, umbilical, and subumbilical at time (T0), after 2 months from the rehabilitation protocol (T1), and then after 4 months of rehabilitation protocol (T2) from approximately 3 months after giving birth, and we saw an early return to sport. Results: Our data analysis reveals that there is an initial decrease in diastasis during the first 2 months with 3 weekly physiotherapy activity sessions in all 4 measurements. One session takes place on site with physiotherapists, while the other 2 are carried out at home using the rehabilitation protocol provided by the medical staff. At the 4-month follow-up, the improvement was similar to the previous follow-up. Conclusion: Of the 37 women analyzed, 6 were referred to the surgeon; 2 for hernias and 4 for diastases greater than 4 cm. The remaining women benefited from a conservative approach. Patients undergoing the rehabilitation protocol showed improvements in all 4 measures, as well as their early return to sport.