Background/Objectives: Impairment in self-awareness (ISA) is one of the common consequences of an acquired brain injury (ABI) and is associated with anosodiaphoria. Collectively, these co-occurring neuropsychological disorders pose significant obstacles in the neurorehabilitation of moderate-to-severe ABI patients. Individuals who recover from ISA may present with anxiety and/or depression as adaptive reactions to the ABI, along with related functional disabilities. The present study investigated whether the level of metacognitive self-awareness (SA) is associated with the presence of anxiety and depression, apathy, or anosodiaphoria in patients with moderate-to-severe ABI. It aimed also at investigating the possible relationship between the severity of disability and both psycho-emotional diseases and the presence of PTSD symptoms in patients with high metacognitive SA. Methods: Sixty patients with moderate-to-severe ABI and different levels of metacognitive SA completed a series of questionnaires, which assessed their self-reported metacognitive SA, anosodiaphoria, anxiety and depression, apathy, and PTSD symptoms. Results: Low-metacognitive-SA patients showed lower levels of anxiety and depression and higher anosodiaphoria than high-metacognitive-SA patients. Patients with high metacognitive SA and high levels of disability showed significant higher states of anxiety and PTSD symptoms than patients with high metacognitive SA and low levels of disability. Conclusions: The neurorehabilitation of individuals with moderate to severe ABI should address, in particular, the complex interaction between ISA and anxiety and depression in patients during the rehabilitation process.

Acquired Brain Injury (ABI) is now widely regarded as a chronic condition but this change in conceptualization has not yet been realized in the way rehabilitation and care are offered and funded in the United States. Similarly, it is widely accepted that an optimized ABI system includes integration across the phases of care and recovery that considers the bio-psycho-socio-ecological (BPSE) dimensions beyond the injury itself. Despite the importance of BPSE factors informing care, typical post-injury care and management remain focused on acute presentation and the biological nature of the injury and there still exists relevant inter-country differences for disorders of consciousness (DoC) neurorehabilitation after severe ABI. This collaboration with Italian colleagues explores and compares the types and locations of rehabilitative services offered in a Post-Coma Unit of neurorehabilitation center in Italy (namely, Santa Lucia Foundation IRCCS in Rome) and in the United States following a “severe” ABI (sABI). This narrative seeks to describe the degree to which both systems utilize a BPSE informed approach to care.

Recent studies have investigated the role of semantic processing in the parafovea using the Rapid Parallel Visual Presentation (RPVP) paradigm, which involves the simultaneous presentation of two words, one in the fovea (W1) and one in the parafovea (W2). Results have shown that both accuracy and response times are influenced by the semantic relatedness between the words. These findings suggest that semantic information can be extracted from the parafovea and in parallel with the processing of the foveal word. In the present study, we aimed to provide further evidence of parallel semantic processing and to gain deeper insight into the availability and spatial distribution of attentional resources when semantic relatedness is present. Two experiments were conducted. In both, the first part replicated the previous RPVP setup: two words were simultaneously presented and participants were required to read them aloud. Frequency and semantic relatedness between the two words were manipulated. Results replicated previous findings. Crucially, each experiment included a second task: as participants began reading the two words, a probe (an asterisk) could appear to the right of the parafoveal word (Experiment 1) or above the foveal word (Experiment 2). Probe detection times and accuracy were equally facilitated at both positions when the two words was of high-frequency and semantically related. In contrast, when W1 was of low-frequency, neither accuracy nor reaction times in probe detection benefited from parafoveal processing, suggesting that an increased load on the foveal word hinders parafoveal processing. Finally, the same probe detection results were obtained – both in terms of mean reaction times and accuracy – across the two spatial positions, indicating an even distribution of attentional resources across foveal and parafoveal words.

Acquired Brain Injury (ABI) refers to brain damage resulting from traumatic or non-traumatic causes, including traumatic brain injury (TBI), stroke, anoxia, infection, or tumours (Kjeldgaard et al....