Advances in neuroRehabilitation of TREM2-related dementia

Abstract

Rationable:The aim of this study is to investigate the effects of an advanced neuroRehabilitation protocol using virtual reality in the treatment of a patient with fronto-temporal dementia due to TREM2 mutation.Patient's concern: A 41-year-old caucasian male, affected by Nasu-Hakola Disease (NHD), presented a 1-year history of change in behavioral and cognitive functioning, before our observation. The onset of the disease was characterized by severe pain in the lower limbs and knees with limitations in the performance of daily life activities.Diagnosis: Motor and cognitive deficits in NHD.Interventions: As the patient was in a chronic phase, to manage his cognitive and motor status, we decided to treat him by using a specific rehabilitation protocol, including 2 different types of training: conventional cognitive and motor treatment and a combined advanced approach using the virtual reality rehabilitation system (VRRS). The two protocols were separated by 4 weeks of rest, to avoid/reduce a cumulative effect. The patient's cognitive and motor profile was assessed three times: that is before (at T0) and after (at T1) the conventional training as well as at the beginning (T2) and at the end of the combined experimental approach (T3).Outcomes: After the combined therapeutic approach with the virtual reality rehabilitation system, we observed a significant reduction in anxiety, apathy, indifference and depressive symptoms with a more evident motor improvement involving the head and the trunk control.Lessons: Virtual reality can be considered a promising tool for the motor and cognitive rehabilitation of rare neurodegenerative disorders, including patients with NHD.Abbreviations: CCT = conventional cognitive training, CNS = central nervous system, CT = conventional training, FTD = frontotemporal dementia, NHD = Nasu-Hakola disease, RCI = reliable change index, SCT-VRRS = standard cognitive training-virtual reality rehabilitation system, SPT = standard physiotherapy, VR = virtual reality, VRRS = virtual reality rehabilitation system.

A narrative review of the use of a cutting-edge virtual reality rehabilitation technology in neurological and neuropsychological rehabilitation

“…Regarding case reports, no improvement in cognitive impairment (as indicated by a reliable change index equal to 1.3) after two months of VRRS based cognitive training was observed in an adult patient with neurocognitive and motor dysfunctions due to brain alterations linked to brain-stem radionecrosis (Tartamella et al, 2020). Similarly, no improvement in global cognition and executive functions was observed in a patient with neurodegenerative disease after VRRS training (De Luca et al, 2022a). Maresca et al (2018) reported improvement in general cognitive status, attention process and prefrontal cortex related executive functioning of a patient with spinal cord injury that underwent combined treatment including both standard treatment (i.e., psychological counselling, standard cognitive training, and physiotherapy) and VRRS cognitive training.…”

“…physiotherapy and occupational therapy), roboticaided training, and sessions of neuromotor training based on VRRS, could provide more advantages than conventional treatment alone in improving motor functions. De Luca et al (2022a) reported an improvement in head and trunk control in a patient with Nasu-Hakola disease (i.e., a rare neurodegenerative disorder) after a multimodal treatment including both VRRS and standard physiotherapy.…”

Virtual Reality for the Rehabilitation of Acquired Cognitive Disorders: A Narrative Review

“…The empirical evidence supporting the use of VR in cognitive rehabilitation has been steadily growing, highlighting its potential to enhance cognitive functions and quality of life for individuals with various neurological conditions [6,[108][109][110][111]. Numerous studies have demonstrated the effectiveness of VR interventions in improving well-being [4,112,113], symptoms of depression, apathy, anxiety, and agitation [45,112,114,115], perceived stress [116], global cognition, and specific cognitive domains such as attention, memory, executive functions (EFs), and spatial awareness [6,110,116].…”

Benefits of Telerehabilitation for Patients With Severe Acquired Brain Injury: Promising Results From a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality

“…Indeed, SABI motor and cognitive therapy should be as intensive and long lasting as possible to allow patients to achieve the best independence and QoL [7]. Notably, neurorehabilitation approaches may be classified into 2 main categories: conventional, using paper-and-pencil exercises (for cognitive tasks) and face-to-face physical interaction with the therapist (for motor tasks) [8,9], and advanced [10,11], using computer-assisted techniques, robotics, or virtual reality (VR) [12][13][14]. Both are based on the use of specific strategies to retrain or alleviate the cognitive [15] and motor [16] alterations in patients with SABI.…”