Introduction: Functional near-infrared spectroscopy (fNIRS) has emerged as a promising neuroimaging modality for investigating cortical activity in auditory and vestibular domains. Its portability, device compatibility, and motion tolerance make it particularly suited for use in populations that are challenging to study with conventional neuroimaging techniques, such as infants and cochlear implant (CI) users. The present study aims to explore the potential and limitations of this neuroimaging technique in the audiological and vestibular fields, offering an integrated perspective across pediatric, adult and elderly populations. Methods: A narrative review of studies using fNIRS in hearing loss, tinnitus, and vestibular disorders was conducted through searches in PubMed and Scopus up to March 2025. Studies were included if they employed fNIRS to investigate cortical responses in individuals with diagnosed hearing loss, chronic tinnitus or to investigate vestibular function. Results: A total of 60 studies were reviewed: 36 on hearing loss, 11 on tinnitus, and 13 on vestibular disorders. In hearing research, fNIRS successfully identified cortical activation patterns related to auditory perception, speech processing, and cross-modal plasticity in CI users across development, adulthood and aging. The technique showed prognostic potential in predicting CI outcomes and monitoring listening effort and cognitive load. In tinnitus research, fNIRS consistently demonstrate hyper-activation in the auditory cortex and altered functional connectivity with frontal-limbic networks, reflecting sensory, cognitive, and emotional involvement. The technique was sensitive to treatment effects following interventions such as transcranial stimulation, acupuncture, and cochlear implantation. In vestibular research, fNIRS enabled the mapping of cortical networks involved in balance control and multisensory integration during various stimulation paradigms, including caloric testing, motion platforms, and optic flow in virtual environments. Although current applications are mostly exploratory, findings suggest fNIRS can capture vestibular-related cortical activity in real-world conditions. Conclusion: fNIRS offers a valuable, non-invasive, and ecologically valid method for investigating auditory and vestibular function across the lifespan. In hearing and tinnitus research, it shows strong potential for clinical translation, especially if methodological standardization is achieved. Applications in vestibular research remain preliminary but promising.

Background: The rising prevalence of neurological disabilities underscores the need for neurorehabilitation units grounded in evidence-based medicine. However, a gap persists between available evidence and its consistent implementation in clinical practice. In this study, we present the experience of a single tertiary medical center and propose a structured, evidence-based framework for stroke neurorehabilitation aimed at standardizing care and improving functional outcomes. Methods: An iterative consensus process adapted from the modified Delphi Panel methodology was conducted. A multidisciplinary panel of clinicians and experts in stroke and neurorehabilitation reviewed evidence-based guidelines addressing upper limb rehabilitation, gait and balance, cognitive rehabilitation, speech and language therapy, and dysphagia. Guidelines were identified through systematic searches of databases, professional society websites, and reference lists, and appraised using the AGREE II instrument by three independent evaluators. Consensus was achieved through remote feedback rounds and structured in-person meetings between November 2023 and March 2024. Agreement was defined as ≥75% panel consensus. Results: Fifty-two guidelines were identified; eight were excluded due to low methodological quality (AGREE II score <6/7). Consensus was reached across all rehabilitation domains through one to three iterative rounds, depending on topic complexity. Agreement was achieved on all proposed assessment tools and intervention items for upper limb, gait and balance, cognitive, speech and language, and dysphagia rehabilitation. Based on consensus outputs, interventions were stratified according to two hierarchical dimensions: behavioral deficits and impairment severity (mild–moderate vs severe), informed by clinical and instrumental assessments and aligned with the International Classification of Functioning, Disability, and Health framework. Conclusions: Using a structured, multidisciplinary consensus approach, we developed evidence-based and context-sensitive neurorehabilitation clinical pathways supported by pragmatic stratification algorithms. This framework provides a reproducible model for translating guideline evidence into standardized inpatient neurorehabilitation practice, with the potential to optimize functional outcomes and quality of life in individuals with neurological disabilities.

Children with onco-hematological diseases require intensive medical treatments that can affect various aspects of their development. In addition to the disease itself, what influences the course of development most are the neurotoxic effects of therapies and frequent hospitalizations, especially if they occur in the first three years of the child’s life. Among these challenges there is the potential for language delay, a condition that can impact their communication abilities and overall development. Background/Objectives: The aim of this study is to examine communicative and linguistic development in a small group of young children diagnosed with different forms of leukemia, rhabdomyosarcoma, and CNS tumors, recruited through the Hematology–Oncology Clinic of the Department of Child and Woman Health (University of Padova). Methods: Child direct (Griffiths III, PinG, PCGO) and parent indirect assessments (PVB, ABAS-II, ASCB) were provided. Results: Griffiths communication subscale scores in children were mainly below average (55.6%), and 44.4% attested at the clinical level in ABAS-II, with the ability to understand being significantly higher than the production of words. However, the two levels of assertiveness–responsiveness obtained balance in 66.7% of cases, and using the Griffiths personal subscale, only 22.2% of children attested below average. Conclusions: Understanding and addressing children’s communication needs is crucial to improve the quality of life of these young patients and foster optimal communicative and linguistic development despite the obstacles they face in order to implement interventions designed specifically for this type of population and their respective families, if necessary.

SignificanceDeaf and hard-of-hearing infants’ hemodynamic response function (HRF) has not yet been characterized. However, without an appropriate estimate of their HRF, neuroimaging modalities relying on hemodynamic responses, e.g., functional magnetic resonance imaging (fMRI) or functional near-infrared spectroscopy (fNIRS), cannot be used reliably in this population, e.g., prior to and following cochlear implantation. We contribute to better theoretical models of and more suitable therapeutic interventions for the neural changes induced by auditory and language deprivation in deaf infants.AimWe aim to characterize the parameters of the HRF of deaf and hard-of-hearing infants in response to Italian.ApproachWe measured 2- to 20-month-old Italian-exposed infants’ HRF to Italian using fNIRS in the bilateral temporal, i.e., auditory, cortices. We characterized the HRF for all infants and for three clinically relevant subsets: (i) monolingual Italian infants, (ii) genetically deaf infants, and (iii) infants aged 5 to 12 months. We computed the following parameters: peak amplitude, time-to-peak, full width at half maximum, and where present, the amplitude and latency of the initial dip and/or the final undershoot, using a model-based parameter fitting approach. We statistically compared these HRF parameters to those of typically hearing infants.ResultsDeaf and typically hearing infants showed largely similar HRFs, with both groups reaching comparable main peak amplitudes. Minor differences have been found in the latencies of some response components.ConclusionsOur results provide the first detailed characterization of the hemodynamic response to native-language speech in deaf and hard-of-hearing infants, improving clinical and therapeutic approaches through more accurate analysis of fMRI and fNIRS data.

Background and Objectives: Facial nerve palsy (FNP) remains a clinically relevant complication after vestibular schwannoma (VS) resection. Recovery trajectories vary according to the severity of neural injury and early postoperative facial function. This study aimed to characterize the temporal pattern of facial nerve recovery during the first postoperative year and to explore factors associated with favorable long-term function. Materials and Methods: We retrospectively analyzed 51 adult patients who developed FNP after VS surgery between 2020 and 2023. Facial nerve function was assessed using the House–Brackmann (HB) grading system and the Sunnybrook Facial Grading System (SBFGS) at discharge and at 1, 3, 6, and 12 months postoperatively. Longitudinal changes were analyzed using non-parametric repeated-measures methods with effect-size estimation. Favorable 12-month facial nerve function was defined as HB grade I–II. Given the limited number of unfavorable outcomes, associations with 12-month recovery were explored using parsimonious Firth-penalized logistic regression models. Results: At discharge, 45.1% of patients had HB II, 29.4% HB III–IV, and 25.5% HB V–VI. Facial function improved significantly during follow-up. Median SBFGS total score increased from 58.0 at discharge to 99.0 at 12 months (Friedman χ² = 118.78, df = 4, p < 0.001; Kendall’s W = 0.58), while HB grade also improved significantly (χ² = 107.48, df = 4, p < 0.001; W = 0.53). At 12 months, 37/51 patients (72.5%) achieved HB I–II and none remained in the HB V–VI category. Synkinesis, defined as an SBFGS synkinesis subscore > 0, was observed in 10/51 patients (19.6%) at 6 months and 19/51 (37.3%) at 12 months. HB grade and SBFGS score at discharge were strongly inversely correlated (Spearman ρ = −0.943, p < 0.001) and were therefore evaluated in separate models. After adjustment for age and tumor size, each one-grade increase in discharge HB was associated with lower odds of favorable 12-month function (OR 0.30, 95% CI 0.11–0.58; p < 0.001), whereas each 10-point increase in discharge SBFGS was associated with higher odds of favorable function (OR 1.90, 95% CI 1.32–3.53; p < 0.001). Conclusions: Facial nerve function showed substantial longitudinal improvement during the first year after VS surgery. Early postoperative facial function was independently associated with 12-month outcome in exploratory penalized regression analyses. Recovery may continue over several months, supporting prolonged functional surveillance, while the independent contribution of rehabilitation and the effect of nerve grafting require evaluation in larger prospective cohorts.

Introduction: Children diagnosed with hemato-oncological cancers need intensive medical treatments and prolonged hospitalizations, which are associated with increased risk of impairment across multiple neurodevelopmental domains, particularly when exposure occurs within the first three years of life. Objective: This pilot study aimed to explore early language performance in children under 36 months of age hospitalized in a pediatric hemato-oncology unit and to preliminarily investigate changes over time and potential associations with an early speech–language stimulation intervention based on shared reading. Specifically, the study investigated differences between language comprehension and production, as well as variations in linguistic outcomes according to gender and pathology type (liquid vs. solid). Methods: The study employed a sample of 29 children aged 2 to 36 months (M = 20.76, SD = 9.52). Baseline linguistic assessment was conducted using observational measures across multiple language domains, including lexical development (PinG), morphosyntactic abilities (PCGO, GALS), and articulatory skills (BAMF), together with an evaluation of general cognitive functioning (Griffiths). The intervention consisted of in-person shared reading sessions combined with concurrent parental counseling. Exploratory analyses were performed to examine changes over time and group-related differences. Results: Among the sample, lexical comprehension exceeded production (p < 0.001). Sex differences emerged only for lexical comprehension, with males performing worse than females (p = 0.048). Comparisons by diagnosis showed that children with solid tumors had significantly better articulation than those with hematologic malignancies (p = 0.018), with a trend toward higher morphosyntactic production. Longitudinal analyses on 13 children re-evaluated after six months of weekly shared reading intervention showed potential improvements in articulation, lexical production, and morphosyntactic production (all p < 0.01). Conclusions: These preliminary findings suggest that children in pediatric hemato-oncology settings may be vulnerable to expressive language difficulties. Shared reading interventions may represent a promising supportive approach for early language stimulation; however, further studies with larger samples and controlled designs are needed to better understand their potential contribution and effectiveness.