Systematic Documentation of Physiotherapy Practice During Usual Care and High-Intensity Gait Training in Inpatient Stroke Rehabilitation.

Cerebellar alterations have been linked not only to sensorimotor deficits but also to a constellation of cognitive, social, and affective dysfunctions known as the Cerebellar Cognitive Affective Syndrome (CCAS) [–]. This syndrome affects both children and adults with congenital or acquired etiologies [–]. Indeed, the cerebellum, particularly its posterior sectors, is increasingly recognized as a critical hub within distributed neural circuits underlying cognitive and social functions, through bidirectional connections with associative and paralimbic cerebral areas [–]. A leading hypothesis posits that the cerebellum supports social cognition by generating internal sequencing predictions based on input from cerebral mentalizing regions, while signaling errors when mismatches occur between anticipated social events and ongoing behaviors [,]. Analogous to its role in the sensorimotor domain [,], the cerebellum modulates higher-order cortical activity in the social domain by maintaining internal models of social action. This mechanism enables optimized feedforward control, which is essential for the fluid and automated execution of social interactions [,]. Consequently, cerebellar dysfunction disrupts these internal models, impairing prediction and resulting in altered social behavior [,]. Despite these neuroscientific advances, rehabilitation strategies for CCAS remain significantly under-researched [,,]. However, preliminary evidence supports the efficacy of Virtual Reality (VR) training for enhancing social cognition in cerebellar patients [,]. Specifically, children and young adults with congenital cerebellar malformations demonstrated greater benefits from a VR intervention tailored to social prediction abilities compared to a control non-social VR motor training. This advantage was reflected not only in improved social prediction performance but also in the generalization of training effects to secondary neuropsychological outcomes, such as theory of mind and inhibitory control []. By providing embodied sensorimotor experiences within complex, interactive social scenarios, VR represents a highly promising tool for rehabilitation [,]. Growing evidence suggests that Non-invasive Brain Stimulation (NIBS), either alone or combined with behavioral interventions, holds promise for mitigating social and cognitive impairments in clinical populations. Techniques such as Transcranial Magnetic Stimulation (TMS) and Transcranial Electrical Stimulation (tES) have been successfully applied to the cerebellum in healthy individuals, advancing our understanding of its role in social cognition (for reviews see [–]). Building on this foundation, several studies have employed repeated sessions of cerebellar neuromodulation to enhance treatment effects and alleviate socio-affective symptoms, reporting positive outcomes across various neurological, neurodevelopmental, and psychiatric conditions [,,]. While therapeutic applications in cerebellar pathology have traditionally targeted motor recovery (e.g., [,]), recent research highlights a novel potential for social cognition. Notably, Oldrati et al. [] demonstrated that a single session of cerebellar anodal transcranial direct current stimulation (tDCS) improved the use of contextual information to predict others’ mental states in adolescents and young adults with cerebellar malformations. This finding underscores the feasibility and therapeutic potential of such approaches in this specific population.