{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T17:27:08Z","timestamp":1787851628519,"version":"build-2784847793"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurol. Int.","Neurology International"],"abstract":"<jats:p>Background\/Objectives: Unilateral Spatial Neglect (USN) is a disabling attentional syndrome occurring after cortical or subcortical stroke, including thalamic lesions. EEG-based neurofeedback (EEG-NF) may support cortical self-regulation, but evidence in spatial neglect remains limited. This case report describes the clinical, neuropsychological, functional, and electrophysiological (quantitative EEG, qEEG) evolution of a patient with USN after a right thalamic hemorrhagic stroke who underwent multidisciplinary rehabilitation including EEG-NF. Methods: A 70-year-old patient underwent a 3-week inpatient multidisciplinary rehabilitation program including physiotherapy, speech and swallowing therapy, conventional cognitive stimulation, and 15 adjunctive EEG-NF sessions. Baseline and post-treatment assessments included clinical, neuropsychological, neglect-specific, functional, affective, and resting-state qEEG measures. Individual change was examined using the Reliable Change Index when suitable psychometric parameters were available, together with published normative and clinical thresholds. Results: After rehabilitation, the Montreal Cognitive Assessment total raw score increased from 20 to 24, reaching the published minimal clinically important difference but not the minimal detectable change. The Frontal Assessment Battery increased from 8 to 12; after adjustment for age and education according to Italian normative data, both scores remained below the normative cut-off. Neglect-specific measures showed reduced spatial asymmetry, increased contralesional target detection, and a Catherine Bergego Scale reduction from 17 to 5, indicating a shift from moderate to mild ecological neglect. Functional independence improved, with reliable change in Functional Independence Measure (FIM) total and cognitive scores and Modified Barthel Index scores. Exploratory qEEG analyses showed condition-dependent spectral and connectivity changes, but findings were heterogeneous and hypothesis-generating. EEG-NF was completed without adverse events. Conclusions: The adjunctive EEG-NF protocol was completed as planned, with no adverse events. Clinical improvement cannot be attributed specifically to neurofeedback because all rehabilitation components were delivered concurrently. Controlled studies are needed to clarify its specific contribution and the durability of the observed improvements in post-stroke spatial neglect.<\/jats:p>","DOI":"10.3390\/neurolint18090167","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:47:13Z","timestamp":1787849233000},"page":"167","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrated Neurorehabilitation Including EEG-Neurofeedback for Unilateral Spatial Neglect After Right Thalamo-Mesencephalic Intracerebral Hemorrhage: A Case Report"],"prefix":"10.3390","volume":"18","author":[{"given":"Anna","family":"Farella","sequence":"first","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Bari Institute, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7717-3071","authenticated-orcid":false,"given":"Gianvito","family":"Lagravinese","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Bari Institute, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3892-5212","authenticated-orcid":false,"given":"Valerio","family":"Manippa","sequence":"additional","affiliation":[{"name":"Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Santacesaria","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Bari Institute, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosanna","family":"Falcone","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit, Bari Institute, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Concetta","family":"Schiavariello","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit, Bari Institute, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Fiore","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit, Bari Institute, 70124 Bari, Italy"},{"name":"Department of Physical and Rehabilitation Medicine, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9518-9252","authenticated-orcid":false,"given":"Giorgia Francesca","family":"Scaramuzzi","sequence":"additional","affiliation":[{"name":"Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6921-3974","authenticated-orcid":false,"given":"Stefania","family":"De Trane","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit, Bari Institute, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6140-9326","authenticated-orcid":false,"given":"Paolo","family":"Taurisano","sequence":"additional","affiliation":[{"name":"Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2147\/NDT.S171461","article-title":"Unilateral spatial neglect after stroke: Current insights","volume":"16","author":"Gammeri","year":"2020","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Gouret, A., Le Bars, S., Porssut, T., Waszak, F., and Chokron, S. (2024). Advancements in brain-computer interfaces for the rehabilitation of unilateral spatial neglect: A concise review. Front. Neurosci., 18.","DOI":"10.3389\/fnins.2024.1373377"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Tonin, L., Pitteri, M., Leeb, R., Zhang, H., Menegatti, E., Piccione, F., and Mill\u00e1n, J.D.R. (2017). Behavioral and cortical effects during attention driven brain-computer interface operations in spatial neglect: A feasibility case study. Front. Hum. Neurosci., 11.","DOI":"10.3389\/fnhum.2017.00336"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1159\/000545473","article-title":"Neglect after isolated thalamic stroke: A systematic review of the literature","volume":"55","author":"Dampfhoffer","year":"2026","journal-title":"Cerebrovasc. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.neuron.2024.01.002","article-title":"The mediodorsal thalamus in executive control","volume":"112","author":"Wolff","year":"2024","journal-title":"Neuron"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"7407241","DOI":"10.1155\/2017\/7407241","article-title":"Increased alpha-rhythm dynamic range promotes recovery from visuospatial neglect: A neurofeedback study","volume":"2017","author":"Ros","year":"2017","journal-title":"Neural Plast."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.rehab.2017.11.001","article-title":"Effect of a single early EEG neurofeedback training on remediation of spatial neglect in the acute phase","volume":"61","author":"Saj","year":"2018","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101561","DOI":"10.1016\/j.rehab.2021.101561","article-title":"Real-time fMRI and EEG neurofeedback: A perspective on applications for the rehabilitation of spatial neglect","volume":"64","author":"Saj","year":"2021","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1080\/09602011.2017.1301262","article-title":"Using real-time fMRI neurofeedback to restore right occipital cortex activity in patients with left visuo-spatial neglect: Proof-of-principle and preliminary results","volume":"29","author":"Robineau","year":"2019","journal-title":"Neuropsychol. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s10072-005-0443-4","article-title":"The Frontal Assessment Battery (FAB): Normative values in an Italian population sample","volume":"26","author":"Appollonio","year":"2005","journal-title":"Neurol. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"179","DOI":"10.17711\/SM.0185-3325.2018.026","article-title":"Validation of the Clock Drawing Test scoring method in older adults with neurocognitive disorder","volume":"41","year":"2018","journal-title":"Salud Ment."},{"key":"ref_12","first-page":"111","article-title":"A short version of the Stroop test: Normative data in an Italian population sample","volume":"12","author":"Caffarra","year":"2002","journal-title":"Nuova Riv. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Karlsson, J., Hammarstr\u00f6m, E., Fogelkvist, M., and Lundqvist, L.O. (2024). Psychometric characteristics of the Hospital Anxiety and Depression Scale in stroke survivors of working age before and after inpatient rehabilitation. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0306754"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1037\/pas0000082","article-title":"The Oxford Cognitive Screen: Validation of a stroke-specific short cognitive screening tool","volume":"27","author":"Demeyere","year":"2015","journal-title":"Psychol. Assess."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1007\/s10072-016-2650-6","article-title":"Italian normative data for a stroke-specific cognitive screening tool: The Oxford Cognitive Screen","volume":"37","author":"Mancuso","year":"2016","journal-title":"Neurol. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1053\/apmr.2003.50062","article-title":"Behavioral assessment of unilateral neglect: Study of the psychometric properties of the Catherine Bergego Scale","volume":"84","author":"Azouvi","year":"2003","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1037\/0022-006X.59.1.12","article-title":"Clinical significance: A statistical approach to defining meaningful change in psychotherapy research","volume":"59","author":"Jacobson","year":"1991","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/S0003-9993(96)90184-7","article-title":"The reliability of the Functional Independence Measure: A quantitative review","volume":"77","author":"Ottenbacher","year":"1996","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1080\/13651501.2020.1746348","article-title":"Psychometric properties of the Montreal Cognitive Assessment (MoCA) in healthy participants aged 18\u201370","volume":"24","author":"Bruijnen","year":"2020","journal-title":"Int. J. Psychiatry Clin. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1080\/13854046.2021.1954244","article-title":"Initial investigation of test\u2013retest reliability of home-to-home teleneuropsychological assessment in healthy, English-speaking adults","volume":"36","author":"Ngo","year":"2022","journal-title":"Clin. Neuropsychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.apmr.2005.08.130","article-title":"Determination of the minimal clinically important difference in the FIM instrument in patients with stroke","volume":"87","author":"Beninato","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1177\/1545968306294729","article-title":"Establishing the minimal clinically important difference of the Barthel Index in stroke patients","volume":"21","author":"Hsieh","year":"2007","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2517658","DOI":"10.1155\/2019\/2517658","article-title":"Responsiveness, minimal clinically important difference, and validity of the MoCA in stroke rehabilitation","volume":"2019","author":"Wu","year":"2019","journal-title":"Occup. Ther. Int."},{"key":"ref_25","first-page":"100222","article-title":"Is the difference real, is the difference relevant: The minimal detectable and clinically important changes in the Montreal Cognitive Assessment","volume":"6","author":"Lindvall","year":"2024","journal-title":"Cereb. Circ. Cogn. Behav."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1080\/09638288.2020.1814429","article-title":"A comparison of test\u2013retest reliability and random measurement error of the Barthel Index and Modified Barthel Index in patients with chronic stroke","volume":"44","author":"Yang","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2758","DOI":"10.1016\/j.neuropsychologia.2010.04.018","article-title":"A simple measure of neglect severity","volume":"48","author":"Rorden","year":"2010","journal-title":"Neuropsychologia"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.pmrj.2014.01.002","article-title":"Severity of spatial neglect during acute inpatient rehabilitation predicts community mobility after stroke","volume":"6","author":"Hung","year":"2014","journal-title":"PM&R"},{"key":"ref_29","unstructured":"ISRCTN Registry (2026, August 24). Electroencephalogram-Neurofeedback (EEG-NF) to Improve Neglect in Stroke Patients. ISRCTN85291842. Available online: https:\/\/www.isrctn.com\/ISRCTN85291842."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Gouret, A., Delaux, A., Le Bars, S., and Chokron, S. (2026). Rewiring Attention: Virtual Reality and Brain\u2013Computer Interfaces in the Rehabilitation of Unilateral Spatial Neglect. J. Clin. Med., 15.","DOI":"10.3390\/jcm15031036"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1177\/15459683261419423","article-title":"Brain Network Connectivity During Resting-State and a Visuospatial Task as a Biomarker for Spatial Neglect in Stroke Patients","volume":"40","author":"Haddadshargh","year":"2026","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Fekete, K., T\u00f3th, J., Horv\u00e1th, L., M\u00e1rton, S., H\u00e9ja, M., Csiba, L., \u00c1roksz\u00e1ll\u00e1si, T., Bagoly, Z., Sulina, D., and Fekete, I. (2021). Neurophysiological examinations as adjunctive tool to imaging techniques in spontaneous intracerebral hemorrhage: IRONHEART Study. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.757078"},{"key":"ref_33","first-page":"CD003586","article-title":"Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury","volume":"7","author":"Longley","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1161\/STROKEAHA.124.046760","article-title":"Recovery of visuospatial neglect with standard treatment: A systematic review and meta-analysis","volume":"55","author":"Overman","year":"2024","journal-title":"Stroke"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.rehab.2017.12.002","article-title":"Single-case experimental designs to assess intervention effectiveness in rehabilitation: A practical guide","volume":"61","author":"Evans","year":"2018","journal-title":"Ann. Phys. Rehabil. Med."}],"container-title":["Neurology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2035-8377\/18\/9\/167\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T17:02:31Z","timestamp":1787850151000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2035-8377\/18\/9\/167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["neurolint18090167"],"URL":"https:\/\/doi.org\/10.3390\/neurolint18090167","relation":{},"ISSN":["2035-8377"],"issn-type":[{"value":"2035-8377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]}}}