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Article ; Online: The Predictive Value of the Verbal Glasgow Coma Scale in Traumatic Brain Injury: A Systematic Review.

Pisano, Francesca / Bilotta, Federico

The Journal of head trauma rehabilitation

2024

Abstract: Background: Traumatic brain injury (TBI) is a major global health concern, imposing significant burdens on individuals and healthcare systems. The Glasgow Coma Scale (GCS), a widely utilized instrument for evaluating neurological status, includes 3 ... ...

Abstract	Background: Traumatic brain injury (TBI) is a major global health concern, imposing significant burdens on individuals and healthcare systems. The Glasgow Coma Scale (GCS), a widely utilized instrument for evaluating neurological status, includes 3 variables: motor, verbal, and eye opening. The GCS plays a crucial role in TBI severity stratification. While extensive research has explored the predictive capabilities of the overall GCS score and its motor component, the Verbal Glasgow Coma Scale (V-GCS) has garnered less attention. Objective: To examine the predictive accuracy of the V-GCS in assessing outcomes in patients with TBI, with a particular focus on functional outcome and mortality. In addition, we intend to compare its predictive performance with other components of the GCS. Methods: A systematic review, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was conducted utilizing the PubMed, Scopus, and Web of Science databases. Inclusion criteria encompassed 10 clinical studies involving patients with TBI, wherein the level of consciousness was assessed using the verbal GCS score. Predominant statistical measures employed were odds ratios (ORs) and area under the curve (AUC). Results: Recorded findings consistently underscore that lower V-GCS scores are associated with adverse functional outcomes and mortality in patients with TBI. Despite the predictive accuracy of the V-GCS, the Motor Glasgow Coma Scale (M-GCS) emerges as a superior predictor. Conclusion: In the context of TBI outcome prediction, the V-GCS demonstrates its efficacy as a prognostic tool. However, the M-GCS exhibits superior performance compared with the V-GCS. These insights underscore the multifaceted nature of TBI assessment and emphasize the necessity of considering distinct components of the Glasgow Coma Scale for comprehensive evaluation. Further research is warranted to refine and improve the application of these predictive measures in clinical practice.
Language	English
Publishing date	2024-02-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	639221-0
ISSN	1550-509X ; 0885-9701
ISSN (online)	1550-509X
ISSN	0885-9701
DOI	10.1097/HTR.0000000000000938
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Article ; Online: Verbal Glasgow Coma Scale as predictor of persistent disorder of consciousness: Insights for improving accuracy and reliability in clinical practice.

Pisano, Francesca / Bilotta, Federico

Clinical neurology and neurosurgery

2024 Volume 240, Page(s) 108274

Abstract: This brief report discusses the relationship between verbal function, disorders of consciousness, and neurological follow-up after acute brain injury. It provides valuable insights for improving the accuracy and reliability of Verbal Glasgow Coma Scale ... ...

Abstract	This brief report discusses the relationship between verbal function, disorders of consciousness, and neurological follow-up after acute brain injury. It provides valuable insights for improving the accuracy and reliability of Verbal Glasgow Coma Scale scoring in clinical practice. The report addresses the need for standardized training and underlines the importance of physiological stabilization before assessment. Clarity in communication, recognition of non-verbal cues, and serial assessments are emphasized as critical factors to reduce the Verbal Glasgow Coma Scale inconsistencies. It also promotes interdisciplinary collaboration and cultural sensitivity to refine the Verbal Glasgow Coma Scale evaluation, improving the prediction of long-term neurological outcomes after acute brain injury and optimizing effective rehabilitation programs. Possible strategies to implement in the routine clinical practice the provided tips are discussed.
MeSH term(s)	Humans ; Glasgow Coma Scale ; Consciousness Disorders/diagnosis ; Consciousness Disorders/physiopathology ; Reproducibility of Results ; Brain Injuries/complications ; Predictive Value of Tests
Language	English
Publishing date	2024-04-02
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	193107-6
ISSN	1872-6968 ; 0303-8467
ISSN (online)	1872-6968
ISSN	0303-8467
DOI	10.1016/j.clineuro.2024.108274
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Article ; Online: The Impact of COVID-19 Lockdown Measures and COVID-19 Infection on Cognitive Functions: A Review in Healthy and Neurological Populations.

Manfredini, Alessio / Pisano, Francesca / Incoccia, Chiara / Marangolo, Paola

International journal of environmental research and public health

2023 Volume 20, Issue 6

Abstract: The COVID-19 pandemic severely affected people's mental health all over the world. This review aims to present a comprehensive overview of the literature related to the effects of COVID-19 lockdown measures and COVID-19 infection on cognitive functioning ...

Abstract	The COVID-19 pandemic severely affected people's mental health all over the world. This review aims to present a comprehensive overview of the literature related to the effects of COVID-19 lockdown measures and COVID-19 infection on cognitive functioning in both healthy people and people with neurological conditions by considering only standardized tests. We performed a narrative review of the literature via two databases, PUBMED and SCOPUS, from December 2019 to December 2022. In total, 62 out of 1356 articles were selected and organized into three time periods: short-term (1-4 months), medium-term (5-8 months), and long-term (9-12 months), according to the time in which the tests were performed. Regardless of the time period, most studies showed a general worsening in cognitive performance in people with neurological conditions due to COVID-19 lockdown measures and in healthy individuals recovered from COVID-19 infection. Our review is the first to highlight the importance of considering standardized tests as reliable measures to quantify the presence of cognitive deficits due to COVID-19. Indeed, we believe that they provide an objective measure of the cognitive difficulties encountered in the different populations, while allowing clinicians to plan rehabilitation treatments that can be of great help to many patients who still, nowadays, experience post-COVID-19 symptoms.
MeSH term(s)	Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Pandemics ; Communicable Disease Control ; Cognition
Language	English
Publishing date	2023-03-10
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20064889
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Editorial: New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia.

Pisano, Francesca / Marangolo, Paola

Brain sciences

2021 Volume 11, Issue 11

Abstract: Aphasia is a highly disabling acquired language disorder, usually caused by left-lateralized brain damage [ ... ]. ...

Abstract	Aphasia is a highly disabling acquired language disorder, usually caused by left-lateralized brain damage [...].
Language	English
Publishing date	2021-11-14
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2651993-8
ISSN	2076-3425
ISSN	2076-3425
DOI	10.3390/brainsci11111508
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Does Executive Function Training Impact on Communication? A Randomized Controlled tDCS Study on Post-Stroke Aphasia.

Pisano, Francesca / Manfredini, Alessio / Castellano, Andrea / Caltagirone, Carlo / Marangolo, Paola

Brain sciences

2022 Volume 12, Issue 9

Abstract: New approaches in aphasia rehabilitation have recently identified the crucial role of executive functions (EFs) in language recovery, especially for people with severe aphasia (PWSA). Indeed, EFs include high-order cognitive abilities such as planning ... ...

Abstract	New approaches in aphasia rehabilitation have recently identified the crucial role of executive functions (EFs) in language recovery, especially for people with severe aphasia (PWSA). Indeed, EFs include high-order cognitive abilities such as planning and problem solving, which enable humans to adapt to novel situations and are essential for everyday functional communication. In a randomized double-blind crossover design, twenty chronic Italian PWSA underwent ten days of transcranial direct current stimulation (tDCS) (20 min, 2 mA) over the right dorsolateral prefrontal cortex (DLPFC). Two conditions were considered, i.e., anodal and sham, while performing four types of cognitive training (alertness, selective attention, visuo-spatial working memory, and planning), all of which were related to executive functions. After anodal tDCS, a greater improvement in selective attention, visuospatial working memory and planning abilities was found compared to the sham condition; this improvement persisted one month after the intervention. Importantly, a significant improvement was also observed in functional communication, as measured through the Communication Activities of Daily Living Scale, in noun and verb naming, in auditory and written language comprehension tasks and in executive function abilities. This evidence emphasizes, for the first time, that tDCS over the right DLPFC combined with executive training enhances functional communication in severe aphasia.
Language	English
Publishing date	2022-09-19
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2651993-8
ISSN	2076-3425
ISSN	2076-3425
DOI	10.3390/brainsci12091265
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Article: DUAL-tDCS Treatment over the Temporo-Parietal Cortex Enhances Writing Skills: First Evidence from Chronic Post-Stroke Aphasia.

Pisano, Francesca / Caltagirone, Carlo / Incoccia, Chiara / Marangolo, Paola

Life (Basel, Switzerland)

2021 Volume 11, Issue 4

Abstract: The learning of writing skills involves the re-engagement of previously established independent procedures. Indeed, the writing deficit an adult may acquire after left hemispheric brain injury is caused by either an impairment to the lexical route, which ...

Abstract	The learning of writing skills involves the re-engagement of previously established independent procedures. Indeed, the writing deficit an adult may acquire after left hemispheric brain injury is caused by either an impairment to the lexical route, which processes words as a whole, to the sublexical procedure based on phoneme-to-grapheme conversion rules, or to both procedures. To date, several approaches have been proposed for writing disorders, among which, interventions aimed at restoring the sub-lexical procedure were successful in cases of severe agraphia. In a randomized double-blind crossover design, fourteen chronic Italian post-stroke aphasics underwent dual transcranial direct current stimulation (tDCS) (20 min, 2 mA) with anodal and cathodal current simultaneously placed over the left and right temporo-parietal cortex, respectively. Two different conditions were considered: (1) real, and (2) sham, while performing a writing task. Each experimental condition was performed for ten workdays over two weeks. After real stimulation, a greater amelioration in writing with respect to the sham was found. Relevantly, these effects generalized to different language tasks not directly treated. This evidence suggests, for the first time, that dual tDCS associated with training is efficacious for severe agraphia. Our results confirm the critical role of the temporo-parietal cortex in writing skills.
Language	English
Publishing date	2021-04-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life11040343
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Article: Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety.

Picano, Chiara / Quadrini, Agnese / Pisano, Francesca / Marangolo, Paola

Brain sciences

2021 Volume 11, Issue 1

Abstract: Aphasia is one of the most socially disabling post-stroke deficits. Although traditional therapies have been shown to induce adequate clinical improvement, aphasic symptoms often persist. Therefore, unconventional rehabilitation techniques which act as a ...

Abstract	Aphasia is one of the most socially disabling post-stroke deficits. Although traditional therapies have been shown to induce adequate clinical improvement, aphasic symptoms often persist. Therefore, unconventional rehabilitation techniques which act as a substitute or as an adjunct to traditional approaches are urgently needed. The present review provides an overview of the efficacy and safety of the principal approaches which have been proposed over the last twenty years. First, we examined the effectiveness of the pharmacological approach, principally used as an adjunct to language therapy, reporting the mechanism of action of each single drug for the recovery of aphasia. Results are conflicting but promising. Secondly, we discussed the application of Virtual Reality (VR) which has been proven to be useful since it potentiates the ecological validity of the language therapy by using virtual contexts which simulate real-life everyday contexts. Finally, we focused on the use of Transcranial Direct Current Stimulation (tDCS), both discussing its applications at the cortical level and highlighting a new perspective, which considers the possibility to extend the use of tDCS over the motor regions. Although the review reveals an extraordinary variability among the different studies, substantial agreement has been reached on some general principles, such as the necessity to consider tDCS only as an adjunct to traditional language therapy.
Language	English
Publishing date	2021-01-02
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2651993-8
ISSN	2076-3425
ISSN	2076-3425
DOI	10.3390/brainsci11010041
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Article ; Online: Conversational Therapy in Aphasia: From Behavioral Intervention to Neuromodulation.

Marangolo, Paola / Pisano, Francesca

Seminars in speech and language

2019 Volume 41, Issue 1, Page(s) 61–70

Abstract: This article describes the conversational therapy approach for the treatment of persons with aphasia (PWAs). Around 1970s, this approach was inspired by a series of pragmatic principles and techniques to aphasia rehabilitation whose main objective was to ...

Abstract	This article describes the conversational therapy approach for the treatment of persons with aphasia (PWAs). Around 1970s, this approach was inspired by a series of pragmatic principles and techniques to aphasia rehabilitation whose main objective was to set up a condition of communicative exchange with the PWA using his/her own available communicative resources. Indeed, although language represents the most powerful behavior that humans use for communicating, within the conversational approach any intentional action (i.e., gestures, body movements, facial expression, drawing) can be used to communicate. For this reason, its application is particularly suitable for severe PWAs whose damage has compromised all the modalities of language (i.e., production, comprehension, reading, and writing). In this perspective, the speech-language pathologist's (SLP's) goal is not necessarily focused on restoring the damaged linguistic functions, still today pursued by the cognitive approach, but to ameliorate the use of language by teaching the PWA compensatory, productive strategies, and strengthening his/her residual communicative abilities. In this review, the fundamental principles of the conversational approach together with its modalities of treatment, which emphasize the importance of an active interaction between the SLP and the PWA, are reported. A brief summary of recent experimental evidence which combines conversational therapy with a noninvasive brain stimulation technique, transcranial direct current stimulation, is also included.
MeSH term(s)	Aphasia/rehabilitation ; Behavior Therapy ; Combined Modality Therapy ; Communication ; Female ; Humans ; Male ; Severity of Illness Index ; Transcutaneous Electric Nerve Stimulation
Language	English
Publishing date	2019-12-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	604960-6
ISSN	1098-9056 ; 0734-0478
ISSN (online)	1098-9056
ISSN	0734-0478
DOI	10.1055/s-0039-3399500
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Article ; Online: Spinal or cortical direct current stimulation: Which is the best? Evidence from apraxia of speech in post-stroke aphasia.

Pisano, Francesca / Caltagirone, Carlo / Incoccia, Chiara / Marangolo, Paola

Behavioural brain research

2020 Volume 399, Page(s) 113019

Abstract: To date, new advances in technology have already shown the effectiveness of non-invasive brain stimulation and, in particular, of transcranial direct current stimulation (tDCS), in enhancing language recovery in post-stroke aphasia. More recently, it has ...

Abstract	To date, new advances in technology have already shown the effectiveness of non-invasive brain stimulation and, in particular, of transcranial direct current stimulation (tDCS), in enhancing language recovery in post-stroke aphasia. More recently, it has been suggested that the stimulation over the spinal cord improves the production of words associated to sensorimotor schemata, such as action verbs. Here, for the first time, we present evidence that transpinal direct current stimulation (tsDCS) combined with a language training is efficacious for the recovery from speech apraxia, a motor speech disorder which might co-occur with aphasia. In a randomized-double blind experiment, ten aphasics underwent five days of tsDCS with concomitant treatment for their articulatory deficits in two different conditions: anodal and sham. In all patients, language measures were collected before (T0), at the end (T5) and one week after the end of treatment (F/U). Results showed that only after anodal tsDCS patients exhibited a better accuracy in repeating the treated items. Moreover, these effects persisted at F/U and generalized to other oral language tasks (i.e. picture description, noun and verb naming, word repetition and reading). A further analysis, which compared the tsDCS results with those collected in a matched group of patients who underwent the same language treatment but combined with tDCS, revealed no differences between the two groups. Given the persistency and severity of articulatory deficits in aphasia and the ease of use of tsDCS, we believe that spinal stimulation might result a new innovative approach for language rehabilitation.
MeSH term(s)	Aged ; Aphasia/etiology ; Aphasia/therapy ; Apraxias/etiology ; Apraxias/therapy ; Articulation Disorders/etiology ; Articulation Disorders/therapy ; Combined Modality Therapy ; Female ; Humans ; Language Therapy ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Spinal Cord Stimulation ; Stroke/complications ; Stroke/therapy ; Transcranial Direct Current Stimulation
Language	English
Publishing date	2020-11-15
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	449927-x
ISSN	1872-7549 ; 0166-4328
ISSN (online)	1872-7549
ISSN	0166-4328
DOI	10.1016/j.bbr.2020.113019
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Article: Conversational Therapy in Aphasia: From Behavioral Intervention to Neuromodulation

Marangolo, Paola / Pisano, Francesca

Seminars in Speech and Language

(Advances in Discourse Assessment and Treatment)

2019 Volume 41, Issue 01, Page(s) 61–70

Series title	Advances in Discourse Assessment and Treatment
Abstract	This article describes the conversational therapy approach for the treatment of persons with aphasia (PWAs). Around 1970s, this approach was inspired by a series of pragmatic principles and techniques to aphasia rehabilitation whose main objective was to set up a condition of communicative exchange with the PWA using his/her own available communicative resources. Indeed, although language represents the most powerful behavior that humans use for communicating, within the conversational approach any intentional action (i.e., gestures, body movements, facial expression, drawing) can be used to communicate. For this reason, its application is particularly suitable for severe PWAs whose damage has compromised all the modalities of language (i.e., production, comprehension, reading, and writing). In this perspective, the speech-language pathologist's (SLP's) goal is not necessarily focused on restoring the damaged linguistic functions, still today pursued by the cognitive approach, but to ameliorate the use of language by teaching the PWA compensatory, productive strategies, and strengthening his/her residual communicative abilities. In this review, the fundamental principles of the conversational approach together with its modalities of treatment, which emphasize the importance of an active interaction between the SLP and the PWA, are reported. A brief summary of recent experimental evidence which combines conversational therapy with a noninvasive brain stimulation technique, transcranial direct current stimulation, is also included.
Keywords	severe aphasia ; conversation ; communication ; aphasia rehabilitation ; tDCS
Language	English
Publishing date	2019-12-23
Publisher	Thieme Medical Publishers
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	604960-6
ISSN	1098-9056 ; 0734-0478
ISSN (online)	1098-9056
ISSN	0734-0478
DOI	10.1055/s-0039-3399500
Database	Thieme publisher's database

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