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We describe the case of a bilingual patient with persistent symptoms largely, although not fully, consistent with those that are usually reported in Gerstmann's syndrome. Twenty months after a spontaneous primary intracranial hemorrhage, the patient was evaluated with a series of neuropsychological tasks and underwent an MRI investigation based on Diffusion Tensor Imaging probabilistic tractography. The patient suffered from dysgraphia (difficulty in the access to the graphemic representation of letter forms), autotopoagnosia (difficulties in locating body parts on verbal command), right–left confusion (difficulties in localizing right and left side of symmetrical body parts), and number processing/calculation impairments (predominant difficulties on transcoding tasks). Probabilistic tractography revealed a relatively spared superior longitudinal fasciculus and severe damage to the subcortical white matter connecting the angular gyrus with other parietal regions, such as the intraparietal sulcus and the supramarginal gyrus. Within the framework of the contemporary cognitive accounts of Gerstmann's syndrome, the case supports the assumption of an anatomical intraparietal disconnection more than a functional Grundstörung (core impairment).

Background: Previous analyses demonstrated a lack of unidimensionality, item redundancy, and substantial administrative burden for the Brain Injury Rehabilitation Trust Personality Questionnaires (BIRT-PQs). Objective: To use Rasch Analysis to calibrate five short-forms of the BIRT-PQs, satisfying the Rasch model requirements. Methods: BIRT-PQs data from 154 patients with severe Acquired Brain Injury (s-ABI) and their caregivers (total sample = 308) underwent Rasch analysis to examine their internal construct validity and reliability according to the Rasch model. Results: The base Rasch analyses did not show sufficient internal construct validity according to the Rasch model for all five BIRT-PQs. After rescoring 18 items, and deleting 75 of 150 items, adequate internal construct validity was achieved for all five BIRT-PQs short forms (model chi-square p-values ranging from 0.0053 to 0.6675), with reliability values compatible with individual measurements. Conclusions: After extensive modifications, including a 48% reduction of the item load, we obtained five short forms of the BIRT-PQs satisfying the strict measurement requirements of the Rasch model. The ordinal-to-interval measurement conversion tables allow measuring on the same metric the perception of the neurobehavioral disability for both patients with s-ABI and their caregivers.

Objective: To assess the internal construct validity (ICV) of the five Brain Injury Rehabilitation Trust Personality Questionnaires (BIRT-PQ) with Classical Test Theory methods. Methods: Multicenter cross-sectional study involving 11 Italian rehabilitation centers. BIRT-PQs were administered to patients with severe Acquired Brain Injury and their respective caregivers. ICV was assessed by the mean of an internal consistency analysis (ICA) and a Confirmatory Factor Analysis (CFA). Results: Data from 154 patients and their respective caregivers were pooled, giving a total sample of 308 subjects. Despite good overall values (alphas ranging from 0.811 to 0.937), the ICA revealed that several items within each scale did not contribute as expected to the total score. This result was confirmed by the CFA, which showed the misfit of the data to a unidimensional model (RMSEA ranging from 0.077 to 0.097). However, after accounting for local dependency found within the data, fitness to a unidimensional model improved significantly (RMSEA ranging from 0.050 to 0.062). Conclusion: Despite some limitations, our analyses demonstrated the lack of ICV for the BIRT-PQ total scores. It is envisaged that a more comprehensive ICV analysis will be performed with Rasch analysis, aiming to improve both the measurement properties and the administrative burden of each BIRT-PQ.

Verbal reasoning is a complex, multicomponent function, which involves activation of functional processes and neural circuits distributed in both brain hemispheres. Thus, this ability is often impaired after brain injury. The aim of the present study is to describe the construction of a new verbal reasoning test (VRT) for patients with brain injury and to provide normative values in a sample of healthy Italian participants. Three hundred and eighty healthy Italian subjects (193 women and 187 men) of different ages (range 16–75 years) and educational level (primary school to postgraduate degree) underwent the VRT. VRT is composed of seven subtests, investigating seven different domains. Multiple linear regression analysis revealed a significant effect of age and education on the participants’ performance in terms of both VRT total score and all seven subtest scores. No gender effect was found. A correction grid for raw scores was built from the linear equation derived from the scores. Inferential cut-off scores were estimated using a non-parametric technique, and equivalent scores were computed. We also provided a grid for the correction of results by z scores

Un evento cerebrolesivo può determinare alterazioni del comportamento relazionale, della personalità e, più in generale, della condotta sociale. Variabili quali la sede e la vastità delle lesioni cerebrali, la personalità premorbosa, la presenza in anamnesi di eventuali disturbi psichiatrici, i disordini cognitivi associati e fattori ambientali possono contribuire allo sviluppo dei disordini comportamentali ed emozionali. L’insieme di questi fattori contribuisce alla grande variabilità delle alterazioni comportamentali e psicologiche in questa popolazione di pazienti, che spesso subiscono importanti limitazioni dell’attività e della partecipazione sociale. Le modificazioni del comportamento, infatti, rappresentano un ostacolo sia alla partecipazione ai programmi riabilitativi sia a un adeguato e soddisfacente reinserimento familiare, sociale, scolastico e lavorativo, essendo inficiata da questi disturbi soprattutto la qualità dei rapporti interpersonali. Negli ultimi decenni la pratica neuroriabilitativa ha focalizzato sempre di più l’attenzione sull’importanza di applicare programmi specifici e individualizzati per i disordini comportamentali conseguenti a una cerebrolesione. Oggi è possibile usufruire di diversi approcci che prevedono un armonico intersecarsi di interventi farmacologici e comportamentali, cognitivi e psicoterapeutici che accompagnano il paziente e la sua famiglia per tutto l’arco della presa in carico riabilitativa e nel follow-up. Nel presente capitolo, dopo una descrizione delle diverse possibili manifestazioni cliniche dei disordini comportamentali e dei loro correlati anatomo-funzionali, saranno descritti gli strumenti di valutazione, di inquadramento e di approfondimento, atti a individuare i fattori che contribuiscono al loro manifestarsi e al loro mantenersi nel tempo. Seguirà una descrizione delle principali metodiche per la riabilitazione dei disordini del comportamento e della evidenza della loro efficacia. L’ultimo paragrafo