References of "Riganello, Francesco"
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See detailThe Reliability of the Progression of Autonomies Scale Applied on Acquired Brain Injured Patients
Arcuri, Francesco; Cortese, Maria Daniela; Riganello, Francesco ULiege et al

in Frontiers in Neurology (2019)

The Progression of Autonomies Scale (PAS) is a behavioral scale useful to assess the autonomy levels in acquired brain-injured patients. It provides a broad profile, assessing different domains of human ... [more ▼]

The Progression of Autonomies Scale (PAS) is a behavioral scale useful to assess the autonomy levels in acquired brain-injured patients. It provides a broad profile, assessing different domains of human activities ranging from personal, domestic, and extradomestic autonomies. This cross-sectional study is aimed at evaluating the reliability of this scale on a large cohort of acquired brain injury (ABI) patients. Fifty-one ABI patients (49% traumatic, 33.3% hemorrhagic, 17.7% other etiologies), hospitalized in the S. Anna Institute of Crotone, Italy (mean age male 46.08 ± 14.53 and mean age female patients 43.2 ± 11.3) were recruited. We found a high level of reliability of the scale, with a coefficient at the inter-rater agreement between substantial (0.61 ≤ k ≤ 0.8) and almost perfect (0.81 ≤ k ≤ 1), and almost perfect at the test-retest (intra-rater). We confirm that the PAS is a well-structured tool for the assessment of the autonomy levels in brain-injured patients. These findings encourage the application of this scale in the clinical practice of rehabilitation unit to design a tailored rehabilitation treatment on real goals and to monitor the generalization of the recovered abilities to the daily routine activities. [less ▲]

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See detailDo Sensory Stimulation Programs Have an Impact on Consciousness Recovery?
Cheng, Lijuan; Cortese, Maria Daniela; Monti, Martin M. et al

in Frontiers in Neurology (2018), 9(826),

Objectives: Considering sensory stimulation programs (SSP) as a treatment for disorders of consciousness is still debated today. Previous studies investigating its efficacy were affected by various biases ... [more ▼]

Objectives: Considering sensory stimulation programs (SSP) as a treatment for disorders of consciousness is still debated today. Previous studies investigating its efficacy were affected by various biases among which small sample size and spontaneous recovery. In this study, treatment-related changes were assessed using time-series design in patients with disorders of consciousness (i.e., vegetative state—VS and minimally conscious state—MCS). Methods: A withdrawal design (ABAB) was used. During B phases, patients underwent a SSP (3 days a week, including auditory, visual, tactile, olfactory, and gustatory stimulation). The program was not applied during A phases. To assess behavioral changes, the Coma Recovery Scale-Revised (CRS-R) was administered by an independent rater on a weekly basis, across all phases. Each phase lasted 4 weeks. In a subset of patients, resting state functional magnetic resonance imaging (fMRI) data were collected at the end of each phase. Results: Twenty nine patients (48 ± 19 years old; 15 traumatic; 21 > a year post-injury; 11 VS and 18 MCS) were included in our study. Higher CRS-R total scores (medium effect size) as well as higher arousal and oromotor subscores were observed in the B phases (treatment) as compared to A phases (no treatment), in the MCS group but not in the VS group. In the three patients who underwent fMRI analyses, a modulation of metabolic activity related to treatment was observed in middle frontal gyrus, superior temporal gyrus as well as ventro-anterior thalamic nucleus. Conclusion: Our results suggest that SSP may not be sufficient to restore consciousness. SSP might nevertheless lead to improved behavioral responsiveness in MCS patients. Our results show higher CRS-R total scores when treatment is applied, and more exactly, increased arousal and oromotor functions. [less ▲]

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See detailA Heartbeat Away From Consciousness: Heart Rate Variability Entropy can discriminate disorders of consciousness and is correlated with resting-state fMRI brain connectivity of the Central Autonomic Network
Riganello, Francesco ULiege; Larroque, Stephen Karl ULiege; Bahri, Mohamed Ali ULiege et al

Poster (2018, October)

Motivation: Heart rate variability (HRV) reflects the heart-brain two-way dynamic interactions[1-5]. HRV entropy analysis quantifies the unpredictability and complexity of the heart rate beats intervals ... [more ▼]

Motivation: Heart rate variability (HRV) reflects the heart-brain two-way dynamic interactions[1-5]. HRV entropy analysis quantifies the unpredictability and complexity of the heart rate beats intervals and over multiple time scales using multiscale entropy (MSE)[6-8]. The complexity index (CI) provides a score of a system’s complexity by aggregating the MSE measures over a range of time scales[8]. Most HRV entropy studies have focused on acute traumatic patients using task-based designs[9]. We here investigate the CI and its discriminative power in chronic patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) at rest, and its relation to brain functional connectivity. Methods: We investigated the CI in short (CIs) and long (CIl) time scales in 16 UWS and 17 MCS sedated. CI for MCS and UWS groups were compared using a Mann-Whitney exact test. Spearman’s correlation tests were conducted between the Coma Recovery Scale-revised (CRS-R) and both CI. Discriminative power of both CI was assessed with One-R machine learning model. Correlation between CI and brain connectivity (detected with functional magnetic resonance imagery using seed-based and hypothesis-free intrinsic connectivity) was investigated using a linear regression in a subgroup of 12 UWS and 12 MCS patients with sufficient image quality. Results and Discussion: Significant differences were found between MCS and UWS for CIs and CIl (0.0001≤p≤0.006). Significant correlations were found between CRS-R and CIs and CIl (0.0001≤p≤0.026). The One-R classifier selected CIl as the best discriminator between UWS and MCS with 85% accuracy, 19% false positive rate and 12% false negative rate after a 10-fold cross-validation test. Positive correlations were observed between CI and brain areas belonging to the autonomic system. CI was found to be significantly higher in MCS compared to UWS patients, with high discriminative power and lower false negative rate than the reported misdiagnosis rate of human assessors, providing an easy, inexpensive and non-invasive diagnosis tool. CI is correlated to functional connectivity changes in brain regions belonging to the autonomic nervous system, suggesting that CI can provide an indirect way to screen and monitor connectivity changes in this neural system. Future studies should investigate further the extent of CI’s predictive power for other pathologies in the disorders of consciousness spectrum. [less ▲]

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See detailA Heartbeat Away From Consciousness: Heart Rate Variability Entropy Can Discriminate Disorders of Consciousness and Is Correlated With Resting-State fMRI Brain Connectivity of the Central Autonomic Network
Riganello, Francesco ULiege; Larroque, Stephen Karl ULiege; Bahri, Mohamed Ali ULiege et al

in Frontiers in Neurology (2018), 9

Background: Disorders of consciousness are challenging to diagnose, with inconsistent behavioral responses, motor and cognitive disabilities, leading to approximately 40% misdiagnoses. Heart rate ... [more ▼]

Background: Disorders of consciousness are challenging to diagnose, with inconsistent behavioral responses, motor and cognitive disabilities, leading to approximately 40% misdiagnoses. Heart rate variability (HRV) reflects the complexity of the heart-brain two-way dynamic interactions. HRV entropy analysis quantifies the unpredictability and complexity of the heart rate beats intervals. We here investigate the complexity index (CI), a score of HRV complexity by aggregating the non-linear multi-scale entropies over a range of time scales, and its discriminative power in chronic patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), and its relation to brain functional connectivity. Methods: We investigated the CI in short (CIs) and long (CIl) time scales in 14 UWS and 16 MCS sedated. CI for MCS and UWS groups were compared using a Mann-Whitney exact test. Spearman's correlation tests were conducted between the Coma Recovery Scale-revised (CRS-R) and both CI. Discriminative power of both CI was assessed with One-R machine learning model. Correlation between CI and brain connectivity (detected with functional magnetic resonance imagery using seed-based and hypothesis-free intrinsic connectivity) was investigated using a linear regression in a subgroup of 10 UWS and 11 MCS patients with sufficient image quality. Results: Higher CIs and CIl values were observed in MCS compared to UWS. Positive correlations were found between CRS-R and both CI. The One-R classifier selected CIl as the best discriminator between UWS and MCS with 90% accuracy, 7% false positive and 13% false negative rates after a 10-fold cross-validation test. Positive correlations were observed between both CI and the recovery of functional connectivity of brain areas belonging to the central autonomic networks (CAN). Conclusion: CI of MCS compared to UWS patients has high discriminative power and low false negative rate at one third of the estimated human assessors' misdiagnosis, providing an easy, inexpensive and non-invasive diagnostic tool. CI reflects functional connectivity changes in the CAN, suggesting that CI can provide an indirect way to screen and monitor connectivity changes in this neural system. Future studies should assess the extent of CI's predictive power in a larger cohort of patients and prognostic power in acute patients. [less ▲]

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See detailMusic, Disorders of Consciousness and heart/brain two-way interaction in severe brain injured patient
Riganello, Francesco ULiege

Scientific conference (2018, July 04)

Activations to pleasant and unpleasant musical stimuli were observed within an extensive neuronal network and different brain structures, as well as in the processing of the syntactic and semantic aspects ... [more ▼]

Activations to pleasant and unpleasant musical stimuli were observed within an extensive neuronal network and different brain structures, as well as in the processing of the syntactic and semantic aspects of the music. The complexity of musical sample was described by Formal Complexity and General Dynamics parameters defined by Imberty’s semiology studies. Studies evidenced a correlation between autonomic activity and emotion evoked by music listening in patients with Disorders of Consciousness (DoC). The measures of heart rate variability (HRV) are thought to indirectly reflect these activities and interaction. Integrative models equate HRV to autonomic nervous system outputs, with HRV reflecting affective, physiological, “cognitive,” and behavioural elements and homeostatic responses. HRV provides tools for the evaluation of responsiveness in DoC and it has proved reliable in physiological research in the absence of conscious behaviour. Studies results put in evidence how the internal structure of the music can change the autonomic response in patients with DoC. Further investigations are required to better comprehend how musical stimulation can modify the autonomic response in DoC patients, in order to administer the stimuli in a more effective way. [less ▲]

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See detailHeart Rate Variability as an indicator of nociceptive pain in disorders of consciousness?
Riganello, Francesco ULiege; Chatelle, Camille ULiege; Schnakers, Caroline et al

Poster (2018, June 22)

Background: Heart rate variability (HRV) has been proposed as an indicator of nociceptive pain processing1 although its reliability as pain indicator remains under debate. The objective was to study the ... [more ▼]

Background: Heart rate variability (HRV) has been proposed as an indicator of nociceptive pain processing1 although its reliability as pain indicator remains under debate. The objective was to study the interest of an HRV complexity analysis2 method as an indicator of nociceptive pain processing in severely brain-injured patients with disorders of consciousness. Methods: Twenty-two patients (11 in minimally conscious state [MCS], 11 in a vegetative state/unresponsive wakefulness syndrome [VS/UWS]) and 14 healthy subjects [HS] were included in this study. We administered a non-noxious and a noxious stimulation while recording the electrocardiographic response was recorded before, during, and following non-noxious and noxious stimulation. The short-term Complexity Index (CIs) was calculated. Mann-Whitney and Wilcoxon’s test were used to investigate differences in CIs according to the level of consciousness (i.e., HS vs patients and VS/UWS vs MCS) and the three conditions (i.e., baseline, non-noxious, noxious). The correlation between the three conditions and the Coma Recovery Scale-Revised3 were investigated by Spearman’s correlations. Results :We observed higher CIs values in HS as compared with patients during baseline and following the noxious stimulation. We also found higher CIs values in MCS vs VS/UWS patients following the noxious condition and lower values in the noxious vs non-noxious condition solely for the VS/UWS group. A correlation was found between CIs in noxious condition and Coma Recovery Scale-Revised scores. Conclusion: our data suggest a less complex autonomic response to noxious stimuli in VS/UWS patients4. Such analysis may help to better understand sympathovagal response to potentially painful environmental stimulation in brain-injured patients. [less ▲]

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See detailA Heartbeat Away From Consciousness: Heart Rate Variability Entropy can discriminate disorders of consciousness and is correlated with resting-state fMRI brain connectivity of the Central Autonomic Network
Riganello, Francesco ULiege; Larroque, Stephen Karl ULiege; Bahri, Mohamed Ali ULiege et al

Poster (2018, June 21)

Motivation: Heart rate variability (HRV) reflects the heart-brain two-way dynamic interactions[1-5]. HRV entropy analysis quantifies the unpredictability and complexity of the heart rate beats intervals ... [more ▼]

Motivation: Heart rate variability (HRV) reflects the heart-brain two-way dynamic interactions[1-5]. HRV entropy analysis quantifies the unpredictability and complexity of the heart rate beats intervals and over multiple time scales using multiscale entropy (MSE)[6-8]. The complexity index (CI) provides a score of a system’s complexity by aggregating the MSE measures over a range of time scales[8]. Most HRV entropy studies have focused on acute traumatic patients using task-based designs[9]. We here investigate the CI and its discriminative power in chronic patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) at rest, and its relation to brain functional connectivity. Methods: We investigated the CI in short (CIs) and long (CIl) time scales in 16 UWS and 17 MCS sedated. CI for MCS and UWS groups were compared using a Mann-Whitney exact test. Spearman’s correlation tests were conducted between the Coma Recovery Scale-revised (CRS-R) and both CI. Discriminative power of both CI was assessed with One-R machine learning model. Correlation between CI and brain connectivity (detected with functional magnetic resonance imagery using seed-based and hypothesis-free intrinsic connectivity) was investigated using a linear regression in a subgroup of 12 UWS and 12 MCS patients with sufficient image quality. Results and Discussion: Significant differences were found between MCS and UWS for CIs and CIl (0.0001≤p≤0.006). Significant correlations were found between CRS-R and CIs and CIl (0.0001≤p≤0.026). The One-R classifier selected CIl as the best discriminator between UWS and MCS with 85% accuracy, 19% false positive rate and 12% false negative rate after a 10-fold cross-validation test. Positive correlations were observed between CI and brain areas belonging to the autonomic system. CI was found to be significantly higher in MCS compared to UWS patients, with high discriminative power and lower false negative rate than the reported misdiagnosis rate of human assessors, providing an easy, inexpensive and non-invasive diagnosis tool. CI is correlated to functional connectivity changes in brain regions belonging to the autonomic nervous system, suggesting that CI can provide an indirect way to screen and monitor connectivity changes in this neural system. Future studies should investigate further the extent of CI’s predictive power for other pathologies in the disorders of consciousness spectrum. [less ▲]

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See detailGalvanic Skin Response e Apprendimento Dello Stimolo Nocicettivo In Pazienti Con Sindrome Da Veglia Aresponsiva: Quali Implicazioni?
Riganello, Francesco ULiege; Cortese, Maria Daniela; Arcuri, Francesco et al

Poster (2018, April 06)

Background The correct diagnosis is a challenge and the assessment, by behavioral scales as Coma Recovery Scale (CSR-R) and Nociception Coma Scale (NCS), remains the best and simple way to assess the ... [more ▼]

Background The correct diagnosis is a challenge and the assessment, by behavioral scales as Coma Recovery Scale (CSR-R) and Nociception Coma Scale (NCS), remains the best and simple way to assess the level of consciousness. The support of the Galvanic Skin Response (GSR) in the assessment of the nociception stimuli could be represent a useful support to evaluate the level of consciousness in patients with DOC. Materials and Method Where recruited 13 healthy control subject (HC) and 20 UWS patients (hospitalized from no more of 15 days). A protocol of classic conditional learning of the nociceptive stimulus (LNS) was applied and results evaluated by GSR analysis. The consciousness status was assessed in the three successive weeks by CRS-R and NCS. The LNS was composed by three phases of 25 seconds 1) phase A: acoustic stimulus 1 associated to a musical stimulus; 2) phase B: acoustic stimulus 2 associated to the nociceptive stimulus; 3) acoustic stimulus 2 associate to absence of stimuli. After 5 minutes of baseline, the sequence A-B-A-A-B-A-B-C (NL) was applied to evaluate the learning of the nociceptive stimulus and the sequence A*-C-C-A*-C-A*-C-A* (NE) to evaluate the extinction of pain learning in the patients group. The entire protocol was developed in 5 steps, where the patients were assessed by CRS-R and NCS administered with an interval of time of one week from each other: T0) CRS-R and NCS assessment 1 week before of LNS protocol; T1) LNS and CRS-R; T2 to T4) CRS-R and NCS. The patients were compared for presence (PT1) or absence (PT0) of LNS. GSR component prominence and width of the last three phases of the NL (A, B and C) was considered for the analysis. Coherence between waves in C and waves in B and A respectively was also considered. Each group were compared for GRS component in A, B and C by Mann-Whitney’s test and A, B and C phases were compared among them by Wilcoxon’s test. PT1 and PT0 were compared in the different time steps (T0 - T4) by Mann-Whitney’s test. Results All the HC subjects showed in the phase C a GSR wave compatible with the learning of the nociceptive stimulus. In the phases A, B and C 6 UWS patients showed a GSR response superimposable with HC. No significant difference was found comparing the phases A, B, and C among them in PT0. PT0 was different for prominence with PT1 and HC (p≤0.001).Significant difference was found comparing the wave’s correlation between A and C, and B and C in HC and PT1, while no difference was found for PT0. Comparing PT1 and PT0 for CRS-T and NCS a significant difference was found in III week (p≤0.003). Conclusion Some patients, diagnosed as UWS patients by the behavioural assessment and clinical consensus, when underwent to the psychophysiological correlates evaluation, show pattern of (nociceptive) stimulus learning. The association between behavioural assessment methods and psychophysiological correlates should allow reducing the misdiagnosis percentage. This diagnosis accuracy could directly improve the intervention and treatment strategies. [less ▲]

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See detailHeart Rate Variability as an indicator of nociceptive pain in disorders of consciousness?
Riganello, Francesco ULiege; Chatelle, Camille ULiege; Schnakers, Caroline et al

in Journal of Pain and Symptom Management (2018)

CONTEXT: Heart rate variability (HRV) is thought to reflect the affective and physiological aspects of pain and is emerging as a possible descriptor of the functional brain organization contributing to ... [more ▼]

CONTEXT: Heart rate variability (HRV) is thought to reflect the affective and physiological aspects of pain and is emerging as a possible descriptor of the functional brain organization contributing to homeostasis. OBJECTIVES: To investigate whether the short-term Complexity Index (CIs; short-term Complexity Index), a measure of HRV complexity, is useful to discriminate responses to potentially noxious and non-noxious stimulation in patients with different levels of consciousness. METHODS: Twenty-two patients (11 minimally conscious state [MCS], 11 vegetative state/unresponsive wakefulness syndrome [VS/UWS]) and 14 healthy controls [HC] were enrolled. We recorded the electrocardiographic response and calculated the CIs before (baseline), during, and following non-noxious and noxious stimulation. Mann-Whitney and Wilcoxon's tests were used to investigate differences in CIs according to the level of consciousness (i.e., HC vs patients and VS/UWS vs MCS) and the three conditions (i.e., baseline, non-noxious, noxious). The correlation between the three conditions and the Coma Recovery Scale-Revised (CRS-R) was investigated by Spearman's correlations. RESULTS: We observed higher CIs values in HC as compared with patients during baseline (p<.034) and following the noxious stimulation (p<.0001). We also found higher values in MCS vs VS/UWS patients following the noxious condition (p<.001) and lower values in the noxious vs non-noxious condition solely for the VS/UWS group (p<.007). A correlation was found between CIs in noxious condition and CRS-R scores. CONCLUSION: Our results suggest a less complex autonomic response to noxious stimuli in VS/UWS patients. Such method may help to better understand sympathovagal response to potentially painful stimulation in brain-injured patients. [less ▲]

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See detailheart rate variability in Disorders of Consciousness
Riganello, Francesco ULiege

Scientific conference (2017, July 11)

Functional neuroimaging has provided indications of direct/indirect functional links between the autonomic control and higher brain activities. An integrated model (the central autonomic network) has been ... [more ▼]

Functional neuroimaging has provided indications of direct/indirect functional links between the autonomic control and higher brain activities. An integrated model (the central autonomic network) has been contrived to describe the interaction among neuronal structures involved in cognitive, sensory, or affective processes and autonomic regulation. The measures of heart rate variability (HRV) are thought to indirectly reflect these activities and interaction; integrative models equate HRV to autonomic nervous system outputs, with HRV reflecting affective, physiological, “cognitive,” and behavioural elements and homeostatic responses. HRV provides tools for the evaluation of responsiveness in Disorders od Consciousness (DoC) and it has proved reliable in physiological research in the absence of conscious behaviour. Previous studies have evidenced a correlation between autonomic activity and emotion evoked, for example by music listening, in healthy subjects as well as in patients with Disorders of Consciousness, finding a correlation between HRV parameters (in particular with the entropy) and complexity of the musical stimuli. Again, the incidence of established clinical indicators of responsiveness (e.g. visual pursuit) in patients with DoC has been proven variable at the single subject, and a correlation with HRV measures has been observed describing a correlation between sympathetic/parasympathetic balance and responsiveness. However, most of the studies were realized in a clinical setting with controlled ambient parameters, and the models developed loss of reliability in a natural ambient. A correct interpretation of data would require also a recording of biometric parameters in the patient's room, and possibly with a recording of 24h, correlating the biometric data with the ambient parameters. Disrupted sleep, in the critically ill patients, is associated with increased morbidity and mortality, and there is sufficient scientific evidence that noise exposure can induce hearing impairment, hypertension and ischemic heart disease, annoyance, sleep disturbance. Similarly, temperature and humidity also play a role for the patient’s conditions. The extensive monitoring of all aspects of the subject’s functional condition and reactivity in his/her daily activity is a prerequisite to understanding the real efficacy of ambient conditions/changes potentially contributing to the recovery of the consciousness in the rehabilitative milieu. [less ▲]

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See detailPain perception and the interruption of artificial nutrition and hydration (ANH) in unresponsive
Leon-Carrion, josè; Riganello, Francesco ULiege; Macrì, Simone et al

Poster (2017, March 29)

Background: In this presentation, we will review the recent literature indicating that some patients with Disorders of Consciousness reveal a form of residual awareness and that they are capable of ... [more ▼]

Background: In this presentation, we will review the recent literature indicating that some patients with Disorders of Consciousness reveal a form of residual awareness and that they are capable of perceiving painful stimuli and exhibiting consistent responses to them. Empirical evidence suggests that, when tested with the appropriate tools, these patients can exhibit consistent reactions to emotionally salient stimuli.Objectives: Based on these findings, we propose that the voluntary withdrawal of ANH should be carefully reconsidered on medical and ethical grounding. For patients with severe pathologies (e.g., terminally ill), the hydration and starvation may have benefits (patients could be intolerant of enteral feeding because of abdominal distension, vomiting, diarrhoea, or fluid overload) and to refuse food and fluids and to have relief of distress through provision of medicine may be a right. However, most patients in VS/UWS are unlikely to be intolerant of nutrition and hydration that are considered basic compassionate care because they promote physical and emotional well-being. Withdrawal of ANH has biologic consequences including distress and pain. Neurophysiological and neuroimage studies are finding ways to assess awareness in VS/UWS patients. The identification of the ‘pain matrix’ along with the design of experimental tools capable of detecting consistent patterns of brain activation in response to noxious stimuli allowed us to integrate the original definitions of pain, which rested largely upon subjective experiences with objective measurements. [less ▲]

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See detailPain Perception in Unresponsive Wakefulness Syndrome May Challenge the Interruption of Artificial Nutrition and Hydration: Neuroethics in Action
Riganello, Francesco ULiege; macri, simone; Alleva, Enrico et al

in Frontiers in Neurology (2016), 7(202),

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See detailLa regolazione sensoriale guidata: “Ambient Intelligence”.
Riganello, Francesco ULiege

Speech/Talk (2016)

The Heart Rate Variability (HRV) analysis represents a non-invasive and robust method to analyze the ANS sympatho-vagal balance. It represents the fluctuation in the time intervals between adjacent heart ... [more ▼]

The Heart Rate Variability (HRV) analysis represents a non-invasive and robust method to analyze the ANS sympatho-vagal balance. It represents the fluctuation in the time intervals between adjacent heart beats and can be analysed in the time or frequency domain, or using non-linear methods during a monitoring lasting from 5 minutes (short-term variability) to more than 24 h (long-term variability) HRV was also correlated to behavioural response in MCS and UWS/VS patients and its decreasing variability was associated to the increasing of critical conditions in these patients. The implementation of an Ambient intelligence system with sensor networks for the continuous automatic monitoring of subjects with severe brain damage and disorder of consciousness could provide an accurate system of observation of the patient-ambient interaction, offering a better support to the clinical decision in the rehabilitation phase. Further, an accurate monitoring of the sympathovagal balance would allow test the visual fixation and eye pursuit response with greater accuracy and have these signs eventually reconsidered as indices of recovered consciousness or predictors of evolution and outcome. The autonomic system functional state should be re-considered as an independent variable potentially affecting other measures of CNS function of varying complexity, from clinical signs to indices of regional brain activation. Improvement and the advancement of the therapeutic approach in the acute phase and new methods of rehabilitation of consciousness with sensory regulation and the application of ambient intelligence could represent a possible new possible approach in the frame of the Disorder of Consciousness. [less ▲]

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See detailHRV e Riabilitazione nei Gravi Disordini di Coscienza
Riganello, Francesco ULiege

Speech/Talk (2016)

The Heart Rate Variability (HRV) analysis represents a non-invasive and robust method to analyse the ANS sympatho-vagal balance. It was also correlated to behavioural response in MCS and UWS/VS patients ... [more ▼]

The Heart Rate Variability (HRV) analysis represents a non-invasive and robust method to analyse the ANS sympatho-vagal balance. It was also correlated to behavioural response in MCS and UWS/VS patients and its decreasing variability was associated to the increasing of critical conditions in these patients. Extensive monitoring of the autonomic nervous system is advisable in the disorders of consciousness, and HRV techniques appear suitable of application in this field. HRV methodologies benefit from being non-invasive and with positive benefit/cost ratios, and measures are obtained at limited costs, labour, and accuracy of recording. Also if indirect, information on the ANS functional state or responsiveness can be obtained also in absence of the subject’s collaboration and when sophisticated experimental designs and data recording procedures are impracticable or difficult as is the case with the severe disorders of consciousness. The Central Autonomic Network, and the two way brain-Heart interaction model provides neuroscientists and clinicians with an independent approach to be used both in the understanding of the HRV descriptors of the autonomic–CNS interaction and supplementing clinical or neuroimaging observations. The current clinical criteria for diagnosis and prognosis of the disorders of consciousness based on neurological signs of responsiveness should be reconsidered. The criteria should include the variability of responsiveness over time, and multiple testing should be mandatory to reduce the risks of misclassification. The correlation with the functional state of the ANS should be regarded as an independent indicator for diagnosis and prognosis and taken into proper account; monitoring should be extensive and focus also on non-neuronal factors. Reclassification of some patients or classes of patients may prove appropriate if based on systematic investigation. [less ▲]

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See detailAutonomic Nervous System and Outcome after Neuro-Rehabilitation in Disorders of Consciousness
Riganello, Francesco ULiege; Cortese, Maria Daniela; Arcuri, Francesco et al

in Journal of Neurotrauma (2016), 33(4), 423-4

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See detailResponsiveness and the Autonomic Control–CNS Two-Way Interaction in Disorders of Consciousness
Riganello, Francesco ULiege

in Monti, Martin M.; Sannita, Walter G. (Eds.) Brain Function and Responsiveness in Disorders of Consciousness (2016)

Functional neuroimaging has documented stimulus- or condition-related regional brain activation in subjects in VS/UWS or minimally conscious state and suggested retained connectivity in segregated ... [more ▼]

Functional neuroimaging has documented stimulus- or condition-related regional brain activation in subjects in VS/UWS or minimally conscious state and suggested retained connectivity in segregated cortical networks. It also provided indications of direct/indirect functional links between the autonomic control and higher brain activities. An integrated model (the central autonomic network) has been contrived to describe the interaction among neuronal structures involved in cognitive, sensory, or affective processes and autonomic regulation. The measures of heart rate variability (HRV) are thought to indirectly reflect these activities and interaction; integrative models equate HRV to autonomic nervous system outputs, with HRV reflecting affective, physiological, “cognitive,” and behavioral elements and homeostatic responses. HRV provides tools for the evaluation of responsiveness in DoC and has proved reliable in physiological research in the absence of conscious behavior. [less ▲]

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See detailHow Can Music Influence the Autonomic Nervous System Response in Patients with Severe Disorder of Consciousness?
Riganello, Francesco ULiege; Cortese, Maria Daniela; Arcuri, Francesco et al

in Frontiers in Neuroscience (2015), 9(461),

Activations to pleasant and unpleasant musical stimuli were observed within an extensive neuronal network and different brain structures, as well as in the processing of the syntactic and semantic aspects ... [more ▼]

Activations to pleasant and unpleasant musical stimuli were observed within an extensive neuronal network and different brain structures, as well as in the processing of the syntactic and semantic aspects of the music. Previous studies evidenced a correlation between autonomic activity and emotion evoked by music listening in patients with Disorders of Consciousness (DoC). In this study, we analyzed retrospectively the autonomic response to musical stimuli by mean of normalized units of Low Frequency (nuLF) and Sample Entropy (SampEn) of Heart Rate Variability (HRV) parameters, and their possible correlation to the different complexity of four musical samples (i.e., Mussorgsky, Tchaikovsky, Grieg, and Boccherini) in Healthy subjects and Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients. The complexity of musical sample was based on Formal Complexity and General Dynamics parameters defined by Imberty's semiology studies. The results showed a significant difference between the two groups for SampEn during the listening of Mussorgsky's music and for nuLF during the listening of Boccherini and Mussorgsky's music. Moreover, the VS/UWS group showed a reduction of nuLF as well as SampEn comparing music of increasing Formal Complexity and General Dynamics. These results put in evidence how the internal structure of the music can change the autonomic response in patients with DoC. Further investigations are required to better comprehend how musical stimulation can modify the autonomic response in DoC patients, in order to administer the stimuli in a more effective way. [less ▲]

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See detailNew approaches and new therapies
Riganello, Francesco ULiege

Scientific conference (2015, November 23)

The diagnosis of prolonged disorders of consciousness remains problematic despite the available guidelines; misdiagnosis between the vegetative state(VS)and minimally conscious state (MCS) is estimated to ... [more ▼]

The diagnosis of prolonged disorders of consciousness remains problematic despite the available guidelines; misdiagnosis between the vegetative state(VS)and minimally conscious state (MCS) is estimated to hover around 40%. The clinical assessment of UWS/VS condition is based on clinical consensus and behavioural scales, as the Coma Recovery Scale-Revised (CRS-R). The difficulty in the assessment of the consciousness level of UWS/VS patients depends frequently by a subjective interpretation of the observed spontaneous and volitional behaviour. In absence of speech, the motor response is the unique possible. However, it is not always easily detectable, leading the examiner to a possible misdiagnosis. The implementation of an Ambient intelligence system with sensor networks for the continuous automatic monitoring of subjects with severe brain damage and disorder of consciousness could provide an accurate system of observation of the patient-ambient interaction, offering a better support to the clinical decision in the rehabilitation phase The system realized in the S. Anna Institute of Crotone was designed to allow real-time analyses of relevant environmental parameters and the subjects’ vital signs. Main purposes are to identify: 1- partially preserved or recovered circadian/ultradian rhythms; 2) functional changes potentially associated to prognostic indicators; 3) momentary subject/environment interactions or functional changes possibly indicative of residual/recovered responsiveness; 4) predictive models of responsiveness. Improvement and the advancement of the therapeutic approach in the acute phase on the one hand, but also new methods of rehabilitation of consciousness with sensory regulation and the application of ambient intelligence are all other perspectives that allow one to shed a new light on the future evolution of this devastating disease, not only for the patient but for all family members and the subsequent fallout aspects of social damage. [less ▲]

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