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Brain Sciences
Special Issues
Palliative Care for Patients with Severe Neurological Impairment
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Palliative Care for Patients with Severe Neurological Impairment

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurorehabilitation".

Deadline for manuscript submissions: 30 March 2026 | Viewed by 3159

Special Issue Editors

Dr. Giovanna Artioli

E-Mail Website
Guest Editor
Department of Medicine and Surgery, University of Parma, Via A Gramsci 14, Parma, Italy
Interests: palliative care; quality of life; qualitative research; holistic assessment
Special Issues, Collections and Topics in MDPI journals
Dr. Federica Dellafiore

E-Mail Website
Guest Editor
Department of Life Health Sciences and Health Professions, Link Campus University, Via del Casale di San Pio V, 44, 00165 Rome, Italy
Interests: cancer nursing; chronic disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Forms of severe neurological impairment (SNI) include chronicity, disorders of the central and peripheral nervous system, intellectual and motor disability, and communication difficulties.

Palliative care aims to improve the quality of life of patients and their families affected by life-threatening illnesses. Results from research and clinical practice suggest integrating palliative care in chronic conditions and in neurological diseases.

This Special Issue will investigate the need for palliative care in patients with severe neurological impairment, chronic conditions of neurological origin, and brain tumours. We particularly encourage the submission of studies on palliative care and neurological diseases, early palliative care, the experiences of caregivers and professionals who care for these patients, multi-professional approaches to neurological palliative care, and strategies to assess and respond to the need for palliative care in neurological patients, considering the patient–family dyad.

The kind of papers that we are soliciting:

In this Special Issue, original research articles and reviews are welcome.

Research areas may include (but are not limited to) the following: primary research, both qualitative and quantitative, encompassing mixed methods research and single, holistic, and multiple case studies, and secondary studies, including scoping reviews, systematic reviews, qualitative reviews and metasyntheses.

Dr. Giovanna Artioli
Dr. Federica Dellafiore
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • severe neurological impairment
  • neurological chronic disease
  • palliative care
  • early palliative care
  • nursing competencies
  • advance care planning
  • caregiver support
  • mental Illness of Healthcare professionals
  • non pharmacological and complementary treatment
  • bio-psyco-social and existential needs of patient and caregiver

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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12 pages, 432 KB  
Article
Animal-Assisted Activities for Patients with Central Nervous System Disease in Acute Rehabilitation Setting
by Vittorio Casati, Valentina Re, Paola Bardasi, Andrea Contini, Pilade Cortellazzi, Angelica Gallarati, Emilia Bozzini, Valentina Castignoli, Gianfranco Lamberti, Fabio Razza, Simona Galante, Chiara Frati, Francesca Ronchetti, Monica Morelli, Emanuela Ricci and Gianluca Ciardi
Brain Sci. 2025, 15(10), 1029; https://doi.org/10.3390/brainsci15101029 - 23 Sep 2025
Viewed by 329
Abstract
Background: Animal-assisted activities (AAA) are participative interventions, designed to lower hospitalization-related stress and anxiety, enhance communicative readiness, improve quality of life and encourage human–animal interaction. The aim of the present study was to evaluate AAA effects in the context of intensive rehabilitation of [...] Read more.
Background: Animal-assisted activities (AAA) are participative interventions, designed to lower hospitalization-related stress and anxiety, enhance communicative readiness, improve quality of life and encourage human–animal interaction. The aim of the present study was to evaluate AAA effects in the context of intensive rehabilitation of patients with spinal cord injury (SCI), traumatic brain injury (TBI), stroke. Methods: AAA in this study were structured by a local specialized association, for small groups of patients (5/7 a time), biweekly; each session lasted 60 min. Each patient participated in 10 sessions of AAA. Evaluation rating scales were administered at T0 (before the first session) and T1 (after the last session, five weeks later) as follows: Neurobehavioral Rating Scale (NRS) in case of patient with stroke/TBI without disorder of consciousness; Hospital Anxiety and Depression Scale (HADS) for SCI patients. Results: A total of 50 patients concluded the study. NRS score for joined TBI and stroke populations varied from a T0 mean value of 32.34 [C.I. 26.83–37.35] to 17.21 [C.I. 12.66–21.76] (46.7%); this difference proved to be statistically significant (p = 0.000). Stroke patients had a 57.6% NRS lowering by mean 28.10 [C.I. 20.55–35.65] points to 12 [C.I. 6.6–17.36], which was significant (p = 0.000); similarly, TBI patients showed a mean decrease of 35.8% points from the initial 41.6 points [C.I. 37.29–45.93] to 26.76 [C.I. 21.94–31.59] (p = 0.002). As for HADS scores a smaller improvement was found in the cohort of SCI patients: anxiety registered a 1 mean point decrease at T1 (21.5%), from the initial 6.5 points [C.I. 3.80–9.34] to 5.1 ones [C.I. 3.17–7.11]. This variation was near the threshold of significance (p = 0.05). Depression domain, instead, improved by 2.35 mean points (37%), from the 6.35 initial points [C.I. 3.45–9.26] to the final 4 [C.I. 2.15–5.98] with reaching of a significant p value (p = 0.03). ANCOVA did not confirm this last value and showed no influence of age and gender on outcome variations. Discussion: AAA showed preliminary evidence to decrease neurobehavioral disorders in patients with high-complexity neurological diseases, particularly stroke and TBI. The role of AAA in SCI patients remains unclear. Future studies should address confounders’ role for these populations, particularly severity of disease. Furthermore, AAA interventions will have to be studied on larger samples, deepening the exact phase to introduce AAA for neurological patients. Lastly, qualitative studies are needed to explore patients’ lived experiences. Full article
(This article belongs to the Special Issue Palliative Care for Patients with Severe Neurological Impairment)
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14 pages, 945 KB  
Article
Understanding the Impact of Multiple Sclerosis on Quality of Life: An Italian Pilot Study
by Elsa Vitale, Roberto Lupo, Ludovica Panzanaro, Rebecca Visconti, Maria Rosaria Tumolo, Paolo Caldararo, Federico Cucci, Donato Cascio, Giorgio De Nunzio, Stefano Botti, Ivan Rubbi and Luana Conte
Brain Sci. 2025, 15(9), 960; https://doi.org/10.3390/brainsci15090960 - 3 Sep 2025
Viewed by 727
Abstract
Backgorund. Multiple sclerosis (MS) profoundly affects the lives of patients and their families. The experience of the disease is shaped not only by its progression and specific characteristics but also by the quality of medical and caregiving support received. The diagnosis of MS [...] Read more.
Backgorund. Multiple sclerosis (MS) profoundly affects the lives of patients and their families. The experience of the disease is shaped not only by its progression and specific characteristics but also by the quality of medical and caregiving support received. The diagnosis of MS represents a transformative event that may lead to job loss, the need for continuous care, and a significant reorganization of family roles. In Italy, more than 140,000 people are affected by MS (AISM data, 2024). The impact of the disease is multifaceted and complex, involving various aspects of the patient’s life. Dependence on external assistance often becomes an unavoidable necessity, highlighting the importance of exploring the quality of life of people with MS in the Italian context. The main objective is to assess the quality of life of individuals affected by MS, both before diagnosis and during the course of the disease. A secondary aim is to identify related psycho-physical consequences, including care-related needs. Methods: An online survey was conducted through various associations operating across Italy, involving a sample of 99 individuals diagnosed with MS. Results: The results show a predominance of female participants, with a mean age of 41 years. The disease was reported to be at an early stage in 66.7% of cases and advanced in 33.3%, with none of the respondents being in a terminal phase. The most frequent clinical form was relapsing–remitting MS (RRMS), which accounted for 78.8% of the cases. In terms of employment and daily activities, more than half of the participants reported underperforming (59.6%) or limiting specific tasks (51.5%) due to disability caused by the disease. Emotional distress had even more pronounced effects, with 63.6% reporting a decline in performance and 62.6% experiencing concentration difficulties. Quality of life was significantly affected, particularly in the physical and emotional domains. Vitality, physical pain, perceived health, and psychological well-being emerged as compromised dimensions, pointing to the need for a multidimensional care model that integrates therapeutic, rehabilitative, and psychosocial interventions. Individuals in the early stages of MS tended to maintain better work relationships and demonstrated higher levels of professional engagement. Conclusions: The findings underscore the importance of a continuous and personalized care approach, addressing not only clinical treatment but also psychological and social support. These aspects are crucial for monitoring patients’ needs, promoting quality of life, facilitating disease acceptance, and mitigating psychological distress. Full article
(This article belongs to the Special Issue Palliative Care for Patients with Severe Neurological Impairment)
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18 pages, 629 KB  
Systematic Review
Relational, Ethical, and Care Challenges in ALS: A Systematic Review and Qualitative Metasynthesis of Nurses’ Perspectives
by Giovanna Artioli, Luca Guardamagna, Nicole Succi, Massimo Guasconi, Orejeta Diamanti and Federica Dellafiore
Brain Sci. 2025, 15(6), 600; https://doi.org/10.3390/brainsci15060600 - 3 Jun 2025
Viewed by 1206
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that leads to severe functional decline and death, imposing significant physical, emotional, and ethical burdens on patients and healthcare providers. With no curative treatment, ALS care depends on the early and sustained integration [...] Read more.
Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that leads to severe functional decline and death, imposing significant physical, emotional, and ethical burdens on patients and healthcare providers. With no curative treatment, ALS care depends on the early and sustained integration of palliative care to address complex and evolving needs. Nurses play a pivotal role in this process, yet their lived experiences remain underexplored. This study aimed to synthesize qualitative evidence on nurses’ experiences in ALS care, with a focus on emotional, ethical, and palliative dimensions. Methods: A meta-synthesis of qualitative studies was conducted using Sandelowski and Barroso’s four-step method. A systematic search across five databases identified eight studies exploring nurses’ experiences with ALS care. Thematic synthesis was applied to extract overarching patterns. Results: Three core themes emerged: (1) Relational Dimension: From challenges to empathy and Trust and mistrust—emphasizing communication barriers and the value of relational trust; (2) Care Dimension: Competence, Palliative care needs, and Rewarding complexity—highlighting the emotional demands of care, the need for timely palliative integration, and the professional meaning derived from ALS care; (3) Ethical Dimension: Medical interventionism and Patient-centered values—exploring dilemmas around life-sustaining treatments, patient autonomy, and end-of-life decisions. Conclusion: Nurses in ALS care face complex emotional and ethical challenges that call for strong institutional support and palliative training. Enhancing palliative care integration from diagnosis, alongside targeted education and psychological support, is crucial to improving care quality and sustaining the well-being of both patients and nurses. Full article
(This article belongs to the Special Issue Palliative Care for Patients with Severe Neurological Impairment)
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