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Hernan G, Ingale N, Somayaji S, Veerubhotla A. Virtual Reality-Based Interventions to Improve Balance in Patients with Traumatic Brain Injury: A Scoping Review. Brain Sci 2024; 14:429. [PMID: 38790408 PMCID: PMC11119161 DOI: 10.3390/brainsci14050429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Virtual reality (VR)-based interventions to improve balance and mobility are gaining increasing traction across patient populations. VR-based interventions are believed to be more enjoyable and engaging for patients with traumatic brain injury. This scoping review aims to summarize existing studies from the literature that used VR to improve balance and mobility and determine the gap in VR-based balance literature specific to individuals with traumatic brain injury. METHODS Two authors independently searched the literature using the search terms "Virtual Reality Traumatic Brain Injury Lower Limb", "Virtual Reality Traumatic Brain Injury Balance", and "Virtual Reality Traumatic Brain Injury Gait". RESULTS A total of seventeen studies, specifically, three randomized controlled trials, one one-arm experimental study, two retrospective studies, two case studies, one feasibility/usability study, one cohort study, and seven diagnostic (validation) studies, met the inclusion criteria for this review. The methodological quality of the studies evaluated using the PEDro scale was fair. DISCUSSION Future studies should focus on large-scale clinical trials using validated technology to determine its effectiveness and dose-response characteristics. Additionally, standard assessment tools need to be selected and utilized across interventional studies aimed at improving balance and mobility to help compare results between studies.
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Affiliation(s)
| | | | | | - Akhila Veerubhotla
- Department of Rehabilitation Medicine, Grossman School of Medicine, New York University, New York, NY 10016, USA; (G.H.); (N.I.); (S.S.)
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Calderone A, Carta D, Cardile D, Quartarone A, Rifici C, Calabrò RS, Corallo F. Use of Virtual Reality in Patients with Acquired Brain Injury: A Systematic Review. J Clin Med 2023; 12:7680. [PMID: 38137752 PMCID: PMC10743630 DOI: 10.3390/jcm12247680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES ABI is found in all societies as the most severe, disabling neurological disorder. A cognitive rehabilitation program is essential for the clinical recovery of these patients, improving functional outcomes and quality of life. Modern technologies such as virtual reality (VR) offer several advantages over traditional therapies, including the ability to engage people in simulated performance of functional tasks. This review will examine the studies in which virtual reality has been used as an aid, technique, or intervention in patients with acquired brain injury. MATERIALS AND METHODS Studies were identified from an online search of PubMed, Cochrane Library, and Web of Science databases. RESULTS We found that TBI patients responded positively to VR treatment depending on the damaged or impaired cognitive and motor functions they acquired. It is now a tool that is available in the rehabilitation of these patients and supports the recovery of various motor and cognitive functions. CONCLUSIONS This review has shown that VR is an intervention technique that increasingly exists in clinical rehabilitation practice for ABI patients. The device uses advanced technologies that can cause general changes in cognitive, motor, and psychological aspects and create a simulated environment that can partially restore these functions and behaviors, as well as the behaviors of everyday life.
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Affiliation(s)
| | | | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy
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Reale G, Fusco A, Calciano R, Vallario N, Vagnarelli G, Caliandro P, Castelli L, Moci M, Tieri G, Iasevoli L, Padua L. The Immediate Effects of Immersive Virtual Reality on Autonomic Nervous System Function in Patients with Disorders of Consciousness after Severe Acquired Brain Injury: A Pilot Study. J Clin Med 2023; 12:7639. [PMID: 38137708 PMCID: PMC10744216 DOI: 10.3390/jcm12247639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Disorders of Consciousness (DoCs) after severe acquired brain injury involve substantial impairment of cognition and physical functioning, requiring comprehensive rehabilitation and support. Technological interventions, such as immersive Virtual Reality (VR), have shown promising results in promoting neural activity and enhancing cognitive and motor recovery. VR can induce physical sensations that may activate the Autonomic Nervous System (ANS) and induce ANS-regulated responses. This study aimed to investigate the effects of immersive VR on the ANS in patients with DoCs through the analysis of the electrodermal activity (EDA). EDA was measured with a wearable device during a single immersive VR session consisting of static and dynamic videos depicting naturalistic environments. A pilot case-control study was conducted with 12 healthy participants and 12 individuals with DoCs. Results showed higher EDA values in patients than in healthy participants (p = 0.035), suggesting stronger autonomic activation during immersive VR exposure, while healthy subjects, in turn, showed a decrease in EDA values. Our results revealed a significant interaction between conditions and groups (p = 0.003), with patients showing significantly increased EDA values from the baseline compared to dynamic video observation (p = 0.014) and final rest (p = 0.007). These results suggest that immersive VR can elicit sympathetic arousal in patients with DoCs. This study highlights the potential of immersive VR as a tool to strengthen autonomic responses in patients with impaired consciousness.
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Affiliation(s)
- Giuseppe Reale
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy (A.F.); (M.M.)
| | - Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy (A.F.); (M.M.)
| | - Rossella Calciano
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Noemi Vallario
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriele Vagnarelli
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Pietro Caliandro
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Letizia Castelli
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy (A.F.); (M.M.)
| | - Marco Moci
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy (A.F.); (M.M.)
| | - Gaetano Tieri
- Virtual Reality and Digital Neuroscience Lab, Department of Law and Digital Society, University of Rome Unitelma Sapienza, Piazza Sassari, 4, 00161 Rome, Italy;
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Luigi Iasevoli
- Multiple Sclerosis Unit, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy (A.F.); (M.M.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Castelli L, Iacovelli C, Fusco A, Amoruso V, Cuccagna C, Loreti C, Giovannini S, Padua L. The Role of Technological Rehabilitation in Patients with Intensive Care Unit Weakness: A Randomized Controlled Pilot Study. J Clin Med 2023; 12:jcm12072612. [PMID: 37048695 PMCID: PMC10095108 DOI: 10.3390/jcm12072612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Intensive-Care-Unit-Acquired Weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients and can have a significant impact on long-term disability. Early rehabilitation has been suggested to facilitate the natural recovery process. This is a pilot, randomized, single-blind study that aimed to evaluate the effectiveness of intensive combined technological rehabilitation treatment including focal muscle vibration and non-immersive virtual reality for patients with severe acquired brain injury (sABI) and ICU-AW. Twenty-four patients were randomized into the conventional group, which performed only conventional rehabilitation, and the experimental group, which also performed technological treatment. At baseline and after 3 weeks of treatment, assessments of motor function, autonomy, disability and quality of life were conducted. At the end of the intervention, both groups showed significant improvements. However, patients in the experimental group achieved greater improvements in disability (p = 0.001) and quality of life (p = 0.001). The results show that intensive structured rehabilitation is effective in improving the motor function, disability and quality of life of patients with severe acquired brain injury and acquired weakness. The combination of non-immersive virtual reality training and focal muscle vibration can result in a significant improvement in overall disability and quality of life compared with conventional treatment alone.
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Affiliation(s)
- Letizia Castelli
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Iacovelli
- Department of Emergency, Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vincenza Amoruso
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cristina Cuccagna
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Claudia Loreti
- Department of Emergency, Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-(0)-6-3015-4382
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Salvalaggio S, Cacciante L, Maistrello L, Turolla A. Clinical Predictors for Upper Limb Recovery after Stroke Rehabilitation: Retrospective Cohort Study. Healthcare (Basel) 2023; 11:healthcare11030335. [PMID: 36766910 PMCID: PMC9913979 DOI: 10.3390/healthcare11030335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
After stroke, recovery of upper limb (UL) motor function is enhanced by a high dose of rehabilitation and is supposed to be supported by attentive functions. However, their mutual influence during rehabilitation is not well known yet. The aim of this retrospective observational cohort study was to investigate the association between rehabilitation dose and motor and cognitive functions, during UL motor recovery. Inpatients with first unilateral stroke, without time restrictions from onset, and undergoing at least 15 h of rehabilitation were enrolled. Data on dose and modalities of rehabilitation received, together with motor and cognitive outcomes before and after therapy, were collected. Fugl-Meyer values for the Upper Extremity were the primary outcome measure. Logistic regression models were used to detect any associations between UL motor improvement and motor and cognitive-linguistic features at acceptance, regarding dose of rehabilitation received. Thirty-five patients were enrolled and received 80.57 ± 30.1 h of rehabilitation on average. Manual dexterity, level of independence and UL motor function improved after rehabilitation, with no influence of attentive functions on motor recovery. The total amount of rehabilitation delivered was the strongest factor (p = 0.031) influencing the recovery of UL motor function after stroke, whereas cognitive-linguistic characteristics were not found to influence UL motor gains.
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Affiliation(s)
- Silvia Salvalaggio
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Via Alberoni 70, 30126 Venice, Italy
- Padova Neuroscience Center, Università degli Studi di Padova, Via Orus 2/B, 35131 Padova, Italy
| | - Luisa Cacciante
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, Via Alberoni 70, 30126 Venice, Italy
- Correspondence: ; Tel.: +39-0412207521
| | | | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences–DIBINEM, Alma Mater Studiorum Università di Bologna, Via Massarenti 9, 40138 Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Pelagio Palagi 9, 40138 Bologna, Italy
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Han Y, Zhang X, Zhang N, Meng S, Liu T, Wang S, Pan M, Zhang X, Yi J. Hybrid Target Selections by "Hand Gestures + Facial Expression" for a Rehabilitation Robot. SENSORS (BASEL, SWITZERLAND) 2022; 23:237. [PMID: 36616835 PMCID: PMC9824727 DOI: 10.3390/s23010237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
In this study we propose a "hand gesture + face expression" human machine interaction technique, and apply this technique to bedridden rehabilitation robot. "Hand gesture + Facial expression" interactive technology combines the input mode of gesture and facial expression perception. It involves seven basic facial expressions that can be used to determine a target selecting task, while hand gestures are used to control a cursor's location. A controlled experiment was designed and conducted to evaluate the effectiveness of the proposed hybrid technology. A series of target selecting tasks with different target widths and layouts were designed to examine the recognition accuracy of hybrid control gestures. An interactive experiment applied to a rehabilitation robot is designed to verify the feasibility of this interactive technology applied to rehabilitation robots. The experimental results show that the "hand + facial expression" interactive gesture has strong robustness, which can provide a novel guideline for designing applications in VR interfaces, and it can be applied to the rehabilitation robots.
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Affiliation(s)
- Yi Han
- The State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China
- Department of Intelligent Mechanical Systems Engineering, Kochi University of Technology, 185 Miyanokuchi, Tosayamada-Cho, Kochi 782-8502, Japan
| | - Xiangliang Zhang
- The State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Ning Zhang
- Key Laboratory of Rehabilitation Technical Aids Technology and System of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
| | - Shuguang Meng
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, Kunming 650000, China
| | - Tao Liu
- The State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Shuoyu Wang
- Department of Intelligent Mechanical Systems Engineering, Kochi University of Technology, 185 Miyanokuchi, Tosayamada-Cho, Kochi 782-8502, Japan
| | - Min Pan
- Department of Mechanical Engineering, University of Bath, Bath BA2 7AY, UK
| | - Xiufeng Zhang
- Key Laboratory of Rehabilitation Technical Aids Technology and System of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China
| | - Jingang Yi
- Department of Mechanical and Aerospace Engineering, Rutgers University, Piscataway, NJ 08854, USA
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Lo SC, Tsai HH. Design of 3D Virtual Reality in the Metaverse for Environmental Conservation Education Based on Cognitive Theory. SENSORS (BASEL, SWITZERLAND) 2022; 22:8329. [PMID: 36366028 PMCID: PMC9654491 DOI: 10.3390/s22218329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Climate change causes devastating impacts with extreme weather conditions, such as flooding, polar ice caps melting, sea level rise, and droughts. Environmental conservation education is an important and ongoing project nowadays for all governments in the world. In this paper, a novel 3D virtual reality architecture in the metaverse (VRAM) is proposed to foster water resources education using modern information technology. METHODS A quasi-experimental study was performed to observe a comparison between learning involving VRAM and learning without VRAM. The 3D VRAM multimedia content comes from a picture book for learning environmental conservation concepts, based on the cognitive theory of multimedia learning to enhance human cognition. Learners wear VRAM helmets to run VRAM Android apps by entering the immersive environment for playing and/or interacting with 3D VRAM multimedia content in the metaverse. They shake their head to move the interaction sign to initiate interactive actions, such as replaying, going to consecutive video clips, displaying text annotations, and replying to questions when learning soil-and-water conservation course materials. Interactive portfolios of triggering actions are transferred to the cloud computing database immediately by the app. RESULTS Experimental results showed that participants who received instruction involving VRAM had significant improvement in their flow experience, learning motivation, learning interaction, self-efficacy, and presence in learning environmental conservation concepts. CONCLUSIONS The novel VRAM is highly suitable for multimedia educational systems. Moreover, learners' interactive VRAM portfolios can be analyzed by big-data analytics to understand behaviors for using VRAM in the future to improve the quality of environmental conservation education.
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Affiliation(s)
- Shih-Che Lo
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei 106335, Taiwan
| | - Hung-Hsu Tsai
- Institute of Data Science and Information Computing, National Chung Hsing University, Taichung 402204, Taiwan
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Challenges and Perspectives for Clinical Applications of Immersive and Non-Immersive Virtual Reality. J Clin Med 2022; 11:jcm11154540. [PMID: 35956157 PMCID: PMC9369665 DOI: 10.3390/jcm11154540] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022] Open
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Corti C, Butti N, Bardoni A, Strazzer S, Urgesi C. Body Processing in Children and Adolescents with Traumatic Brain Injury: An Exploratory Study. Brain Sci 2022; 12:brainsci12080962. [PMID: 35892403 PMCID: PMC9331706 DOI: 10.3390/brainsci12080962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
Dysfunctions in body processing have been documented in adults with brain damage, while limited information is available for children. This study aimed to investigate body processing in children and adolescents with traumatic brain injury (TBI) (N = 33), compared to peers with typical development. Two well-known computerized body-representation paradigms, namely Visual Body Recognition and Visuo-spatial Imagery, were administered. Through the first paradigm, the body inversion and composite illusion effects were tested with a matching to sample task as measures of configural and holistic processing of others’ bodies, respectively. The second paradigm investigated with a laterality judgement task the ability to perform first-person and object-based mental spatial transformations of own body and external objects, respectively. Body stimuli did not convey any emotional contents or symbolic meanings. Patients with TBI had difficulties with mental transformations of both body and object stimuli, displaying deficits in motor and visual imagery abilities, not limited to body processing. Therefore, cognitive rehabilitation of body processing in TBI might benefit from the inclusion of both general training on visuo-spatial abilities and specific exercises aimed at boosting visual body perception and motor imagery.
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Affiliation(s)
- Claudia Corti
- Scientific Institute, IRCCS E. Medea, Via Don Luigi Monza 20, 23842 Bosisio Parini, Italy; (N.B.); (A.B.); (S.S.)
- Correspondence:
| | - Niccolò Butti
- Scientific Institute, IRCCS E. Medea, Via Don Luigi Monza 20, 23842 Bosisio Parini, Italy; (N.B.); (A.B.); (S.S.)
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, 34127 Trieste, Italy
| | - Alessandra Bardoni
- Scientific Institute, IRCCS E. Medea, Via Don Luigi Monza 20, 23842 Bosisio Parini, Italy; (N.B.); (A.B.); (S.S.)
| | - Sandra Strazzer
- Scientific Institute, IRCCS E. Medea, Via Don Luigi Monza 20, 23842 Bosisio Parini, Italy; (N.B.); (A.B.); (S.S.)
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, 33078 San Vito al Tagliamento, Italy;
- Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine, 33100 Udine, Italy
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