Acquired brain injury (ABI) represents non-progressive cerebral damage occurring after birth (eg., trauma, hypoxia, stroke). ABIs affect several domains, including cognitive functions. Specifically, up to 80% of ABI patients show attentional deficits that highly impact their quality of life and independence by hampering the execution of daily tasks. Since cognitive rehabilitation seems to be only mildly effective in treating these deficits, it is crucial to explore more effective tools for neurorehabilitation. Among emerging techniques, neurofeedback (NF) can effectively improve attentional abilities in patients with ADHD. NF is a training where a subject receives online feedback on their brainwaves, with the goal to normalize brain oscillations through operant conditioning. It is a promising tool for attention rehabilitation of ABI patients, however, currently only 30% of subjects are able to master NF techniques. Transcranial alternating current stimulation (tACS) is a non-invasive electrical stimulation technique that, by delivering a weak current to the brain, can entrain specific frequencies in the brain. Thus, tACS (by increasing the target frequency of NF) could facilitate NF and increase its effectiveness. Our study has 2 aims: 1) to validate NF as an attentional rehabilitation tool for ABI patients; 2) to show that tACS can increase NF effectiveness. We will perform a randomized double-blind placebo-controlled trial with 75 subjects with ABI (with mixed etiologies, matched by cognitive profile) with 3 arms: a) NF alone, b) NF+tACS , c) Control group. Both tACS and NF will target β power. We will have measures for efficacy, transfer to daily life and motivation of the intervention. This innovative protocol will validate a new tool for ABI patients’ neurorehabilitation and open new doors for the combined use of NF+tACS in other rehabilitation fields.

The recovery of the functional use of the upper limb is a main goal of rehabilitation in stroke survivors. Despite the development of many rehabilitation programs, upper limb paresis following a stroke still results in disability and a great societal cost. Attention deficits are also common in these patients. Here we propose two mixed-reality (MR) interventions to improve functional outcomes of the rehabilitation interventions as compared with classic rehabilitation programs. MR interfaces allow patients to use real world objects while interacting with virtual images, which enhances the use of real world objects. Virtual Reality allows recreating an ecological setting, which is key to the transfer of the rehabilitation outcomes. In the first intervention, patients will be able to train with real and also the same virtual objects and that in an enriched environment. To better understand how MR contributes to the mechanisms of neuroplasticity, in this first experiment, we also seek to compare cinematic measures of object manipulation (virtual vs. real). In the second MR intervention, an avatar will mimic the patient’s gestures and movements with real objects. This will give the patient an allocentric perspective of their movement. Moreover, these interventions will allow us to test the hypothesis that a MR motor training environment might have a beneficial effect on attention. Participants will be recruited from the pool of patients from the stroke outpatient program of NISA Hospital and clinical staff will contribute to data collection. The outcomes of those interventions will be compared with the outcomes of the conventional rehabilitation program (i.e. occupational therapy and physiotherapy without virtual or MR). We will not only assess motor function, but also attention and motivation. We expect to find better outcomes by following the MR interventions.

The overall goal of DoCMA is to enhance international research on Disorders of Consciousness (DoC) by strengthen the collaboration among project participants to leverage the shared scientific and expert know-how in the field. The partnerships will be instrumental in addressing, therefore, the following specific objectives: Specific Objective 1) Consolidating of a joint international scientific and innovation programme for developing research projects on DoC diagnosis, evaluation and management of patients. Specific Objective 2) Establishing a standardised methodology, common approach and data sharing resources to enable data access and research collaborations concerning DoC. Specific Objective 3) Contributing to transfer of knowledge and quality of life of the individuals, by generating new services, technologies and/or products to respond to the society needs concerning DoC. In short, this action will increase the scientific competence of the consortium members at the international level in DoC research and clinical practice, enhancing the transfer of knowledge and professional skills on evidence-based interventions and validated technology for a better management of patients. To reach the mentioned goal, the partnership is composed by ten partners from different countries in Europe (Austria, Belgium, Germany, Italy, and Spain), covering a wide range of expertise, and bringing together academic and non-academic entities.

DoCBox aims to develop a new toolbox of fast and easy-to-implement behavioural, neuroimaging and neurophysiological assessments to accurately assess and diagnose patients suffering from a disorder of consciousness (DoC), allowing for a more comprehensive examination and better management of this vulnerable population. This toolbox will respond to the society needs regarding the evaluation of patients with DoC as it appropriately responds to the rigid time constraints of clinical settings, which are one of the biggest limitations for an accurate diagnosis. This project aims to enhance interdisciplinary research on DoC via an exchange of knowledge and international scientific cooperation to translate and validate the tools (e.g., behavioral scales, pipelines) that will be included in this toolbox. This collaboration between the partners underpins the credibility and feasibility of three research objectives: 1) Provide new bedside assessment tools to refine and optimize the detection of consciousness signs in post-comatose patients; 2) Identify the most accurate neurophysiological and neuroimaging biomarkers of consciousness states and develop novel easy-to-use software to implement these analyses in clinical settings; 3) Engage informal and formal caregivers in the diagnosis of DoC patients. This will ultimately result in guidelines and policy recommendations for improvement of DoC patients’ diagnosis and thus care. The proposed exchange program aims to bring together a large international and interdisciplinary consortium of 17 partners (EU and non-EU countries) including researchers and other professionals with all necessary skills, permitting to tackle the challenges faced by professionals when studying and caring for DoC patients. The benefits for Europe are the intersector and interdisciplinary massive data collected by this consortium, which will allow a major progress in the understanding of (disorders of) consciousness.