Four-time Paralympic champion Alex Zanard in continuing his recovery from a serious handcycling crash in June last year ©Getty Images

Four-time Paralympic gold medallist Alex Zanardi has "started talking" again and "communicated with his family".

This was the latest assessment of Zanardi’s condition by Federica Alemanno, a neuropsychologist at the San Raffaele hospital in Milan.

The Italian icon, who won two gold medals in Para cycling at both London 2012 and Rio 2016, is undergoing treatment at the hospital after sustaining serious injuries from a handcycling crash in June last year.

According to Italian newspaper Corriere della Sera, Zanardi underwent "awake surgery" - a procedure used by neurosurgeons to preserve and test the patient’s brain function.

"It was a great emotion when he started talking, nobody believed it," said Alemanno. 

"He was there, and he communicated with his family."

Zanardi continues to show signs of improvement in his recovery as some of his senses reportedly returned last month.

Doctors confirmed the 54-year-old was able to shake hands on demand and raise his thumb to signal "okay".

Alex Zanardi claimed two gold medals in Para cycling at both London 2012 and Rio 2016 ©Getty Images
Alex Zanardi claimed two gold medals in Para cycling at both London 2012 and Rio 2016 ©Getty Images

Zanardi’s wife, Daniela Manni told La Stampa: "He does things, but not always.

"There have been steps forward, and there have been steps backwards.

"His is a very long journey."

Zanardi was placed in a medically-induced coma after colliding with a road vehicle during a race near Siena in June 2019.

He was moved to a rehabilitation centre only to return to hospital in late July, where he underwent a fourth brain operation.

In September, it was confirmed Zanardi had surgery "aimed at craniofacial reconstruction".

Two months later, San Raffaele hospital said Zanardi had "reached a physical and neurological condition of general stability".

Zanardi competed in Formula One and motorsport series during the 1990s.

In 2001, while racing in the Championship Auto Racing Teams, he suffered a life-changing accident and lost both legs.

Following the accident, Zanardi was fitted with two prosthetic limbs and after competing at the World Touring Car Championship turned to Para-cycling.

Zanardi has won six Paralympic medals, including four golds and two silvers.

He won road time trial golds at London 2012 and Rio 2016 as well as mixed team relay gold in Brazil and a road race gold in 2012.