ABSTRACT
The purpose of the study was twofold: 1) to evaluate the effectiveness of goal-oriented neuropsychological rehabilitation, with EEG-Neurofeedback, devel-oped for a visual artist with PTSD resulting from infection with SARS-CoV-2, followed by a severe course of neuroCovid and sequelae of long term phar-macological coma, 2) to evaluate QEEG/ERP results showing a reduction of late-onset PTSD symptoms (as defined by DSM-5) over the course of the sub-ject's rehabilitation. The present study describes a 67-year-old right-handed visual artist with PTSD after infection with SARS-CoV-2, resulting in severe course of COVID-19 com-plicated by acute respiratory distress syndrome (ARDS). She was referred to the ICU, put on a respirator and treated during 13 weeks of pharmacologically induced coma. After returning home she received rehabilitation to improve motor functioning, and was referred for further diagnosis and therapy to the Reintegration and Training Center of the Polish Neuropsychological Society. In neuropsychological diagnosis she presented with neurocognitive dysfunc-tions, including lost ability to paint. In the course of rehabilitation she received a program of rehabilitation with two components: 1. Program A, consisting in goal-oriented neuropsychological rehabilitation, including art therapy, aimed at the reduction of the neurocognitive dysfunctions (Pąchalska 2008). This program lasted for 9 months (from the beginning of March till the end of November 2022). 2. Program B, based on the most commonly used form of EEG-Neurofeed-back: frequency/ power EEG-Neurofeedback, using 2 bipolar surface elec-trodes, called "surface neurofeedback” (Kropotov 2016). She received Theta/ Beta, SMR training, including (1) at C3, strengthening Beta1 and inhibiting Theta + inhibiting Beta 2,and (2) at C4, strengthening SMR and inhibiting Theta + inhibiting Beta, based on the international 10-20 system (Thompson & Thompson 2012). This program was given after a diagnosis of PTSD with late onset (as defined by DSM-5), from the beginning of August till the end of No-vember, twice a week. Almost all the short and the long-term side effects of neuroCOVID (including the PTSD) were reduced in severity. The artist showed marked improvement and was able to return to painting. The artwork she made after her illness is in high demand with art collectors, which has improved the patient's quality of life. Goal-oriented neuropsychological rehabilitation, with art therapy, supported with EEG-Neurofeedback administered for a visual artist with PTSD with de-layed onset (as defined by DSM-5) resulting from infection with SARS-CoV-2, followed by severe neuroCovid symptoms and the sequelae of long-term phar-macologically-induced coma, canbe helpful in the reduction of short term side effects, such as neurocognitive dysfunctions (attention, memory, dysexecutive symptoms) and long-term side effects, such as various physical and mental symptoms, including PTSD. It can be also helpful in the reintegration of the Self System. © 2022, MEDSPORTPRESS Publishing House. All rights reserved.
ABSTRACT
Successful neuroprotection is only possible with contemporary microvascular protection. The prevention of disease-induced vascular modifications that accelerate brain damage remains largely elusive. An improved understanding of pericyte (PC) signalling could provide important insight into the function of the neurovascular unit (NVU), and into the injury-provoked responses that modify cell-cell interactions and crosstalk. Due to sharing the same basement membrane with endothelial cells, PCs have a crucial role in the control of endothelial, astrocyte, and oligodendrocyte precursor functions and hence blood-brain barrier stability. Both cerebrovascular and neurodegenerative diseases impair oxygen delivery and functionally impair the NVU. In this review, the role of PCs in central nervous system health and disease is discussed, considering their origin, multipotency, functions and also dysfunction, focusing on new possible avenues to modulate neuroprotection. Dysfunctional PC signalling could also be considered as a potential biomarker of NVU pathology, allowing us to individualize therapeutic interventions, monitor responses, or predict outcomes.
Subject(s)
Endothelial Cells , Pericytes , Astrocytes , Blood-Brain Barrier/pathology , Cell Communication , Endothelial Cells/physiology , Pericytes/pathologyABSTRACT
Background: The rehabilitation of patients with chronic prosopagnosia that occurs following a stroke is a challenge for modern medicine. Dysfunction to the facial processing areas is permanent and standard rehabilitation brings only limited improvement. Therefore, therapists suggest reinforcing the compensatory strategies used by such patients such as voice, figure, and gait recognition to help with the identification of a particular person, which promotes their social functioning. New neurotechnologies, especially QEEG/ERPs, displays of functional brain impairment in prosopagnosia, may be helpful in developing an appropriate neurotherapy protocol and create the conditions for other forms of rehabilitation in such patients. The purpose of our study was twofold: 1) to evaluate QEEG/ERPs shows of post-stroke functional impairment associated with prosopagnosia, 2) to construct a neurofeedback protocol based on these indices to support the neuropsychological rehabilitation of the case study described herein. Case report: We present the case of a 23-year-old right-handed student of the Graphics Faculty of the Academy of Fine Arts, with chronic associative prosopagnosia after infection with SARS-CoV-2 followed by Covid-19 and a right hemisphere stroke. He was referred in April 2021 for diagnosis and therapy at the Reintegration and Training Center of the Polish Neuropsychological Society (PTNeur). Six months earlier, in October 2020, the patient had been admitted to the Infectious Disease Hospital. COVID-19 was diagnosed based on coronavirus 2 (SARS-CoV-2) reverse transcription PCR (RT-PCR) on a nasopharyngeal swab. The neurological examination revealed muscle weakness on the left side of the body, slow and aprosodic speech, preserved comprehension, and acute left homonymous hemianopsia, as well as prosopagnosia and mirror symptom. The patient was sedated and mechanically ventilated for six days. The CT-scan showed foci in the posterior part of the superior temporal lobe and hyperintense changes in the blood supply area of the right middle cerebral artery. After 30 days of hospitalization, the patient was discharged from this hospital and referred to an outpatient rehabilitation center for five months. Therapy improved his general condition but did not remove the chronic prosopagnosia: a personal tragedy for the patient which prevented him from continuing his studies. He was diagnosed at the PTNeur Reintegration and Training Center within the next few weeks: (1). ophthalmologic examinations revealed no pathology;(2) neuropsychological testing confirmed the presence of chronic apperceptive prosopagnosia;(3) examination of event-related potentials (ERPs) revealed a large delay of the N170 wave, particularly on the right side, indicating a slowing of the rate of nerve impulses in early face processing and a cause of prosopagnosia. The patient was referred for rehabilitation: he participated in 20 sessions of individually tailored anodal transcranial direct current stimulation (tDCS) twice a week for ten weeks, and in parallel, for individualized Prosopagnosia Symbolic Art Therapy provided once a week for ten weeks. By the end of therapy, the patient was not only recognizing but also painting portraits of faces. He returned to college, finished and defended a master's thesis in Artistic Drawing, in which facial presentation played an important role. Conclusions: Quantitative EEG (QEEG) and event-related potentials (ERPs) neuromarkers helped to understand the mechanism of prosopagnosia and to choose an individualized protocol, thus the appropriate application of tDCS in our patient, which accelerated the recovery of the ability to perform complex tasks and created the conditions for Symbolic Art Therapy. Modern medicine can successfully use such a management protocol in individuals with chronic prosopagnosia. (PsycInfo Database Record (c) 2022 APA, all rights reserved)