Ferti-Care Medical vibrator
Intro music by: Art of Decay
Live To Roll – This is my personal knowledge and experience about having sex after a SCI as well as how to best achieve ejaculation during sex and masturbation.
Source: PHYSIOTHERAPY BOOKS
PURPOSE: To explore the experiences of individuals who have had a severe
traumatic brain injury (TBI) and their carers in the first month post-discharge
from in-patient rehabilitation into living in the community.
METHOD: Using a qualitative approach underpinned by critical realism, we explored the narratives of 10 patients and nine carers using semi-structured interviews approximately one month post-discharge. Thematic analysis was carried out independently by two researchers.
RESULTS: Firstly, perceptions of support were mixed but many patients and carers felt unsupported in the inpatient phase, during transitions between units and when preparing for discharge. Secondly, they struggled to accept a new reality of changed abilities, loss of roles and loss of autonomy. Thirdly, early experiences post-discharge exacerbated fears for the future.
CONCLUSIONS: Most patients and carers struggled to identify a cohesive plan that supported their transition to living in the community. Access to services required much persistence on the part of carers and tended to be short-term, and therefore did not meet their long-term needs. We propose the need for a case manager to be involved at an early stage of their rehabilitation and act as a key point for information and access to on-going rehabilitation and other support services. Implications for Rehabilitation Traumatic Brain Injury (TBI) is a major cause of long-term disability. It can affect all areas of daily life and significantly reduce quality of life for both patient and carer. Professionals appear to underestimate the change in abilities and impact on daily life once patients return home. Community services maintain a short-term focus, whereas patients and carers want to look further ahead – this dissonance adds to anxiety. The study’s findings on service fragmentation indicate an urgent need for better integration within health services and across health, social care and voluntary sectors. A link person/case manager who oversees the patient journey from admission onwards would help improve integrated care and ensure the patient, and
carer, are at the center of service provision.
Source: Traumatic Brain Injury Resource Guide – Research Reports – Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community
Everyone has said “I’m tired” at one point or another. But those deceptively simple words can have so many meanings. Without knowing the extent of the exhaustion someone with chronic illness is feeling when they say they’re people may think your “tiredness” can be cured by a nap or early night, like theirs, not understanding the support you really need in that moment.
So we asked our Mighty community with chronic illness to reveal what they might actually mean when they say, “I’m tired.” It’s important for the people in your life to understand the challenges you’re dealing with and the empathy and kindness that can help you get through them.
Here’s what our community told us:
1. “Most people who are healthy don’t understand that ‘I’m tired’ is a very shortened phrase for us. When I actually admit to friends and family that I feel bad or am tired that means so much. That means I can no longer mask the symptoms I deal with on a daily basis and I need a little compassion to get through the next few hours or sometimes days.”
2. “When I say ‘I’m tired,’ I mean my body hurts to the point I can’t explain to a ‘normal’ person how bad it hurts. It means mentally, emotionally and physically I do not want to keep going. When I say ‘I’m tired’ I’m giving myself permission for a second to stop fighting my illness and to be vulnerable. When I say ‘I’m tired’ I’m trusting you enough to show you how I really feel before I get ready to get up and keep fighting again.”
3. “I don’t want to stop helping you, but I’m pretty sure I’m going to crumble if I do one more thing. So, just smile and nod as I go sit down and put my brace on.”
4. “Just sitting in a chair is exhausting. I just want to be able to melt into the floor because I don’t have the energy to hold myself up. I’m not sleepy, I’m exhausted!”
5. “When I say ‘I’m tired’ it means I don’t want to talk about it right now. It means I’m tired of the fight my body is constantly in against itself, I’m tired of being positive, I’m tired of pushing through the pain, I’m tired of never-ending procedures and continuous doctor appointments that tend to only discover new problems. I know everything will be OK and my faith will get me through this, but right now ‘I’m tired’ and don’t have the energy or the will to put that much effort in to finding the good in my situation.”
6. “‘I’m tired’ is code for: I’ve hit the exhaustion wall/power-off button; I don’t have the energy to explain the systemic overload my body and mind are experiencing; I need to be alone; I’m sorry I can’t do that for you right now, but I’m incapable of even doing that for myself.”
7. “Most of the time it actually means, ‘I know you mean well, but please give me some space. I’d like to be alone.’ Predominantly this is when I really am absolutely exhausted and have zero energy to consider those around me.”
8. “I’m mentally exhausted from having to keep it together on the surface at work, when what I really want to do is scream out loud with the pain. The majority of my day is spent ticking down the clock so I can go home and curl up and just be in pain out loud.”
9. “Half the time it means I don’t have any reason for feeling the way I do emotionally, mentally, or physically, but I feel I need to give one. The other half of the time it’s that I’m at my breaking point and there’s not enough rest or time away in the world to bring me out of it.”
10. “It’s usually my go-to response for pain, exhaustion, anxiety, everything. It’s easier than trying to explain something ‘normal’ people will never understand. Tiredness is something everyone can comprehend on some level.”
11. “I want, no need, to collapse right here. I’m in so much pain I want to cry, but it isn’t socially acceptable to do that. I can’t think straight enough to know my own name, let alone what I should be doing right now!”
12. “When I say I’m tired I mean I can’t keep smiling and acting as if nothing was happening. My whole day I try to show my best, I pretend to be the same person I was before the pain started. When I’m tired I cannot pretend anymore, I have to be who I am now.”
13. “I’m emotionally drained. But I don’t want to appear weak or go into details. Saying, ‘I’m just tired’ is simpler sometimes.”
14. “I say ‘I’m tired,’ but what I mean is I am fatigued beyond exhaustion, I can barely function, I feel like I haven’t slept in days, my body and mind ache for restful rest!”
15. “When I say I am tired, it means wherever I am could make a good place to lay down and hopefully sleep. The concrete floor over there? Yeah that looks like an amazing place.”
16. “I’m out of spoons. Of juice. Of battery. I physically cannot muster the energy needed to complete the task(s) being asked of me.”
17. “I’ll stare off into the brain fog and when someone notices, auto respond, ‘I’m just tired.’ It’s so much easier not to have to explain something you know they likely don’t understand. My being tired can’t be fixed. Take a nap, cured. If only it were that simple.”
This is part one of a three-part article published to health.mil.
Vision Problems After Brain Injury
Visual problems following brain trauma are frequent and often complex. It is probably easiest to define the problems based upon how they affect incoming visual information (i.e., the afferent visual pathways) or the outflow of information to the visual organs (i.e., efferent visual pathways). Afferent defects include reduction in visual acuity, visual field, color vision, contrast sensitivity, comfort (usually as it relates to glare), and higher level visual processing, including recording of visual memory and comprehension of visual stimuli. Efferent defects include reduction of the ability to visually pursue a target, focus the lens inside the eye, train the two eyes onto a single target, maintain gaze once a visual target is obtained, and open and close the eyelids. In this three part series, we will describe 1) damage to the afferent visual pathways, 2) damage to the efferent visual pathways, and 3) the role of the neuro-ophthalmologist in visual restoration and rehabilitation.
The Afferent Visual Pathway and How Brain Injury Can Affect It
Light enters the eye through the cornea, the clear window of the eye. The cornea provides the majority of the focusing power of the eye, and is an extremely poor refractive surface, but with a healthy tear film it becomes nearly perfect. Brain injury often causes dry eye thereby reducing visual acuity. Furthermore, brain injury patients often lose an adequate blink response or develop lagophthalmos, the inability to completely close the eye. Dry, unprotected corneas are subject to scarring and infection.
Trauma to the brain often entails injury that can also shake or directly damage the eye along with the rest of the body. Patients suffering a blast injury can experience rapid elevation of pressure in the chest, which is then transmitted by the blood vessels to the retina, the neural tissue lining the inner wall of the eye. This is the tissue which converts light rays into the electrical impulses that are sent to the brain. The retinal blood vessels can rupture from the sudden increase in pressure and cause bleeding within the retina, a condition called Purtscher’s retinopathy. The free blood inside the eye can cause significant scarring and loss of vision.
Direct head trauma can also cause the eye to move too quickly and/or too far relative to the fixed structures in the eye socket. This can cause stretching or shearing of the optic nerve, the nerve that carries visual information to the brain. This traumatic optic neuropathy often can result in permanent visual impairment. Multiple direct head traumas also are a risk factor for problems within the eye itself, such as detachment of the retina from the back of the eye, or formation of a cataract, a clouding of the natural lens.
Trauma to the head invariably is associated with some degree of trauma to the neck, a risk factor for damage to the blood vessels of the neck. Injury to the wall of an artery can cause it to bulge (i.e., form an aneurysm) or separate from its inner lining (i.e., arterial dissection). Either situation can lead to abnormal blood flow to the visual pathways of the brain. Furthermore, either condition can cause the vessels to physically compress portions of the visual pathways, such as the nerves that control the eye muscles or the nerves that bring visual information to the brain. This could result in double vision or in reduction of visual acuity and visual field, respectively.
It has been demonstrated that the world we see is formed into a map upon our brain, specifically onto an area called the visual cortex. This map is organized such that the image of the world is inverted and reversed; the left side of our brain sees what is to the right of where we look and the right side of the brain sees light from the left of where we gaze. Furthermore, visual information emanating from above our visual point of interest is transmitted to the lower portion of the visual cortex while the upper portion of the visual cortex maps the visual world below the object of regard. It is for this reason that damage to the visual cortex causes loss of peripheral vision rather than simply loss of visual clarity.
While we do not know how visual memories are created or stored in our brains, it is known that brain injury slows the acquisition and processing of visual information and impairs the formation of visual memory. Recent research has suggested that these impairments may result from stretching or shearing of nerve fiber bundles after head injury. Sadly, higher level visual processing failure is often particularly difficult for a patient to express. Neuropsychologists have proven to be critically important for the diagnosis of these problems and for guidance in directing rehabilitation efforts.
From Stars and Stripes, March 2010, Health.mil.
0:12 I would like to tell you about the most embarrassing thing that has ever happened to me in my years of working as a palliative care physician. This happened a couple of years ago. I was asked as a consultant to see a woman in her 70s — retired English professor who had pancreatic cancer. I was asked to see her because she had pain, nausea, vomiting … When I went to see her, we talked about those symptoms and in the course of that consultation, she asked me whether I thought that medical marijuana might help her. I thought back to everything that I had learned in medical school about medical marijuana, which didn’t take very long because I had learned absolutely nothing. And so I told her that as far as I knew, medical marijuana had no benefits whatsoever. And she smiled and nodded and reached into the handbag next to the bed, and pulled out a stack of about a dozen randomized controlled trials showing that medical marijuana has benefits for symptoms like nausea and pain and anxiety. She handed me those articles and said, “Maybe you should read these before offering an opinion … doctor.”
1:30 So I did. That night I read all of those articles and found a bunch more. When I came to see her the next morning, I had to admit that it looks like there is some evidence that marijuana can offer medical benefits and I suggested that if she really was interested, she should try it. You know what she said? This 73-year-old, retired English professor? She said, “I did try it about six months ago. It was amazing. I’ve been using it every day since. It’s the best drug I’ve discovered. I don’t know why it took me 73 years to discover this stuff. It’s amazing.”
2:11 That was the moment at which I realized I needed to learn something about medical marijuana because what I was prepared for in medical school bore no relationship to reality.
2:22 So I started reading more articles, I started talking to researchers, I started talking to doctors, and most importantly, I started listening to patients. I ended up writing a book based on those conversations, and that book really revolved around three surprises — surprises to me, anyway. One I already alluded to — that there really are some benefits to medical marijuana. Those benefits may not be as huge or as stunning as some of the most avid proponents of medical marijuana would have us believe, but they are real. Surprise number two: medical marijuana does have some risks. Those risks may not be as huge and as scary as some of the opponents of medical marijuana would have us believe, but they are real risks, nonetheless. But it was the third surprise that was most … surprising. And that is that a lot of the patients I talked with who’ve turned to medical marijuana for help, weren’t turning to medical marijuana because of its benefits or the balance of risks and benefits, or because they thought it was a wonder drug, but because it gave them control over their illness. It let them manage their health in a way that was productive and efficient and effective and comfortable for them.
3:37 To show you what I mean, let me tell you about another patient. Robin was in her early 40s when I met her. She looked though like she was in her late 60s. She had suffered from rheumatoid arthritis for the last 20 years, her hands were gnarled by arthritis, her spine was crooked, she had to rely on a wheelchair to get around. She looked weak and frail, and I guess physically she probably was, but emotionally, cognitively, psychologically, she was among the toughest people I’ve ever met. And when I sat down next to her in a medical marijuana dispensary in Northern California to ask her about why she turned to medical marijuana, what it did for her and how it helped her, she started out by telling me things that I had heard from many patients before. It helped with her anxiety; it helped with her pain; when her pain was better, she slept better. And I’d heard all that before. But then she said something that I’d never heard before, and that is that it gave her control over her life and over her health. She could use it when she wanted, in the way that she wanted, at the dose and frequency that worked for her. And if it didn’t work for her, then she could make changes. Everything was up to her. The most important thing she said was she didn’t need anybody else’s permission — not a clinic appointment, not a doctor’s prescription, not a pharmacist’s order. It was all up to her. She was in control.
5:00 And if that seems like a little thing for somebody with chronic illness, it’s not — not at all. When we face a chronic serious illness, whether it’s rheumatoid arthritis or lupus or cancer or diabetes, or cirrhosis, we lose control. And note what I said: “when,” not “if.” All of us at some point in our lives will face a chronic serious illness that causes us to lose control. We’ll see our function decline, some of us will see our cognition decline, we’ll be no longer able to care for ourselves, to do the things that we want to do. Our bodies will betray us, and in that process, we’ll lose control. And that’s scary. Not just scary — that’s frightening, it’s terrifying. When I talk to my patients, my palliative care patients, many of whom are facing illnesses that will end their lives, they have a lot of be frightened of — pain, nausea, vomiting, constipation, fatigue, their impending mortality. But what scares them more than anything else is this possibility that at some point, tomorrow or a month from now, they’re going to lose control of their health, of their lives, of their healthcare, and they’re going to become dependent on others, and that’s terrifying.
6:17 So it’s no wonder really that patients like Robin, who I just told you about, who I met in that clinic, turn to medical marijuana to try to claw back some semblance of control. How do they do it though? How do these medical marijuana dispensaries — like the one where I met Robin — how do they give patients like Robin back the sort of control that they need? And how do they do it in a way that mainstream medical hospitals and clinics, at least for Robin, weren’t able to? What’s their secret? So I decided to find out.
6:54 I went to a seedy clinic in Venice Beach in California and got a recommendation that would allow me to be a medical marijuana patient. I got a letter of recommendation that would let me buy medical marijuana. I got that recommendation illegally, because I’m not a resident of California — I should note that. I should also note, for the record, that I never used that letter of recommendation to make a purchase, and to all of you DEA agents out there —
7:22 love the work that you’re doing, keep it up.
7:26 Even though it didn’t let me make a purchase though, that letter was priceless because it let me be a patient. It let me experience what patients like Robin experience when they go to a medical marijuana dispensary. And what I experienced — what they experience every day, hundreds of thousands of people like Robin — was really amazing. I walked into the clinic, and from the moment that I entered many of these clinics and dispensaries, I felt like that dispensary, that clinic, was there for me. There were questions at the outset about who I am, what kind of work I do, what my goals are in looking for a medical marijuana prescription, or product, what my goals are, what my preferences are, what my hopes are, how do I think, how do I hope this might help me, what am I afraid of. These are the sorts of questions that patients like Robin get asked all the time. These are the sorts of questions that make me confident that the person I’m talking with really has my best interests at heart and wants to get to know me.
8:33 The second thing I learned in those clinics is the availability of education. Education from the folks behind the counter, but also education from folks in the waiting room. People I met were more than happy, as I was sitting next to them — people like Robin — to tell me about who they are, why they use medical marijuana, what helps them, how it helps them, and to give me advice and suggestions. Those waiting rooms really are a hive of interaction, advice and support.
9:03 And third, the folks behind the counter. I was amazed at how willing those people were to spend sometimes an hour or more talking me through the nuances of this strain versus that strain, smoking versus vaporizing, edibles versus tinctures — all, remember, without me making any purchase whatsoever. Think about the last time you went to any hospital or clinic and the last time anybody spent an hour explaining those sorts of things to you. The fact that patients like Robin are going to these clinics, are going to these dispensaries and getting that sort of personalized attention and education and service, really should be a wake-up call to the healthcare system. People like Robin are turning away from mainstream medicine, turning to medical marijuana dispensaries because those dispensaries are giving them what they need.
9:57 If that’s a wake-up call to the medical establishment, it’s a wake-up call that many of my colleagues are either not hearing or not wanting to hear. When I talk to my colleagues, physicians in particular, about medical marijuana, they say, “Oh, we need more evidence. We need more research into benefits, we need more evidence about risks.” And you know what? They’re right. They’re absolutely right. We do need much more evidence about the benefits of medical marijuana. We also need to ask the federal government to reschedule marijuana to Schedule II, or to deschedule it entirely to make that research possible. We also need more research into medical marijuana’s risks. Medical marijuana’s risks — we know a lot about the risks of recreational use, we know next to nothing about the risks of medical marijuana. So we absolutely do need research, but to say that we need research and not that we need to make any changes now is to miss the point entirely. People like Robin aren’t seeking out medical marijuana because they think it’s a wonder drug, or because they think it’s entirely risk-free. They seek it out because the context in which it’s delivered and administered and used, gives them the sort of control they need over their lives. And that’s a wake-up call we really need to pay attention to.
11:16 The good news though is that there are lessons we can learn today from those medical marijuana dispensaries. And those are lessons we really should learn. These are often small, mom-and-pop operations run by people with no medical training. And while it’s embarrassing to think that many of these clinics and dispensaries are providing services and support and meeting patients’ needs in ways that billion-dollar healthcare systems aren’t — we should be embarrassed by that — but we can also learn from that. And there are probably three lessons at least that we can learn from those small dispensaries.
11:51 One: we need to find ways to give patients more control in small but important ways. How to interact with healthcare providers, when to interact with healthcare providers, how to use medications in ways that work for them. In my own practice, I’ve gotten much more creative and flexible in supporting my patients in using drugs safely to manage their symptoms — with the emphasis on safely. Many of the drugs I prescribe are drugs like opioids or benzodiazepines which can be dangerous if overused. But here’s the point. They can be dangerous if they’re overused, but they can also be ineffective if they’re not used in a way that’s consistent with what patients want and need. So that flexibility, if it’s delivered safely, can be extraordinarily valuable for patients and their families. That’s number one.
12:39 Number two: education. Huge opportunities to learn from some of the tricks of those medical marijuana dispensaries to provide more education that doesn’t require a lot of physician time necessarily, or any physician time, but opportunities to learn about what medications we’re using and why, prognoses, trajectories of illness, and most importantly, opportunities for patients to learn from each other. How can we replicate what goes on in those clinic and medical dispensary waiting rooms? How patients learn from each other, how people share with each other.
13:13 And last but not least, putting patients first the way those medical marijuana dispensaries do, making patients feel legitimately like what they want, what they need, is why, as healthcare providers, we’re here. Asking patients about their hopes, their fears, their goals and preferences. As a palliative care provider, I ask all my patients what they’re hoping for and what they’re afraid of. But here’s the thing. Patients shouldn’t have to wait until they’re chronically seriously ill, often near the end of life, they shouldn’t have to wait until they’re seeing a physician like me before somebody asks them, “What are you hoping for?” “What are you afraid of?” That should be baked into the way that healthcare is delivered.
13:58 We can do this — we really can. Medical marijuana dispensaries and clinics all across the country are figuring this out. They’re figuring this out in ways that larger, more mainstream health systems are years behind. But we can learn from them, and we have to learn from them. All we have to do is swallow our pride — put aside the thought for a minute that because we have lots of letters after our name, because we’re experts, because we’re chief medical officers of a large healthcare system, we know all there is to know about how to meet patients’ needs.
14:31 We need to swallow our pride. We need to go visit a few medical marijuana dispensaries. We need to figure out what they’re doing. We need to figure out why so many patients like Robin are leaving our mainstream medical clinics and going to these medical marijuana dispensaries instead. We need to figure out what their tricks are, what their tools are, and we need to learn from them. If we do, and I think we can, and I absolutely think we have to, we can guarantee all of our patients will have a much better experience.
15:00 Thank you.
[Helping Others Understand is an open-ended, intermittent series designed to support stroke survivors and family caregivers with helping friends and family better understand the nuances, complications and realistic expectations for common post-stroke conditions. If there is a specific post-stroke condition you’d like to see us address in future issues, we invite you to let us know: email@example.com.]
Stroke is unpredictable both in its arrival and in the consequences it leaves, but one common stroke deficit is fatigue. Some studies indicate that as many as 70 percent of survivors experience fatigue at some time following their stroke. Unlike exertional fatigue that we feel after working in the yard, post-stroke fatigue occurs from doing typical everyday tasks or sometimes from not doing anything. “It is a fatigue associated with the nervous system, which is quite difficult to understand,” said Jade Bender-Burnett, P.T., D.P.T., N.C.S., a neurological physical therapist in Falls Church, Virginia. “It’s very frustrating to the person who’s living with it because, unlike exertional fatigue, post-stroke fatigue doesn’t always resolve after you take a break, or get some rest.”
That has been Roman Nemec’s experience since surviving an ischemic stroke 11 years ago. It doesn’t seem to matter how much sleep he gets, “I walk around tired all the time, even after 9-10 hours of sleep,” he said from his home in Georgia.
This can be difficult for friends and family members to get their heads around because they have not likely experienced this kind of brain fatigue. Bender-Burnett has asked her clients who were marathoners prior to their stroke to compare the fatigue one feels following a marathon to post-stroke fatigue: “They said the fatigue you feel after damage to the brain is unlike any fatigue they’ve ever felt,” she said.
While there is no standardized scale for post-stroke fatigue, Bender-Burnett says that therapists distinguish between two types of fatigue. “Objective fatigue occurs when we can see physical, mental or cognitive changes,” she said. “With subjective fatigue we don’t see any changes, but the survivor will tell you that they’re feeling extremely weary and have no energy.”
For some this goes on for a few months after their stroke, for others, like Roman, it is persistent. Fatigue may be a side effect of medication. “Post-stroke fatigue is very individualized,” Bender-Burnett said. “One of the most frustrating parts of post-stroke fatigue is that it’s so unpredictable. Today, getting up, brushing your teeth and putting on your clothes may be fine, but tomorrow you may not be able to complete the morning routine without a rest break. That unpredictability is very frustrating for people and makes reintegration into daily life difficult.”
Post-stroke fatigue often changes over time. People report more and greater fatigue in the first six months. It’s episodic at first and seems to come out of nowhere: “They may be functioning well, and then all of a sudden they hit a wall,” she said. “It seems that as they get farther along in recovery, those hit-the-wall episodes decrease, and the lingering effect is ‘I just don’t have the energy to do all the things on my plate.’”
Life consequences span the spectrum from nuisance to career-ending. It can impact a survivor’s ability to function in unpredictable ways: As they tire, they may become clumsy or their speech may be affected. Their ability to understand, comprehend or recall may be compromised. Some people get irritable, while others experience increased emotional lability (crying or laughing with no apparent trigger). Bender-Burnett has worked with people who have made remarkable recoveries but were not able to return to work because of post-stroke fatigue.
Just as the consequences are individualized, so are the responses. If your energy is better in the morning, then take advantage of that. For mental fatigue, the most effective response is to sit quietly with low sensory stimulation, not necessarily take a nap. Some survivors may require regular and scheduled rest breaks or even a nap; that does not work for Roman: “I just live through it,” he said. “There are worse things than being tired. I feel good; I can get around; I can talk. Life is good compared to what it could be. Being tired all the time is not a big problem.”
Rhonda Hand, whose significant other, Tarvin, is a survivor, said: “In our household the fatigue issue is factored in before any event or activity and recuperation time after an event or activity. We just block off rest time like another activity; if we don’t, everything shuts down, including speech. Over the years, we have become much more proactive in scheduling appointments with anybody. There is nothing before 8 a.m. That’s when deep sleep is happening.”
Knowing your limits — and quitting before you hit them — is key to living with post-stroke fatigue. Survivors with fatigue have limited energy reserves, and if they get depleted, they take longer to replenish. “You don’t want push to the point just before you’re exhausted, you want to end on a high note, leaving some reserves,” Bender-Burnett said.
“We’re still learning about post-stroke fatigue from the healthcare perspective, and so I think it’s important that we all be willing to recognize it and have open communication about it,” Bender-Burnett said. “I urge family members and friends to come from a position of compassion and understanding rather than expectation that everything should be better, because, much like depression, others can’t always see it but, if you’re feeling it, it can be quite limiting.”
The Stroke Connection team knows that it can sometimes be hard for family and friends to understand how profoundly post-stroke fatigue may be impacting a survivor. We encourage you to share this article with the people in your life — and, for those pressed for time, we’ve created a quick-reference sheet that you can print or share via email or socia
UNIVERSITY PARK, Pa. — Using game features in non-game contexts, computers can learn to build personalized mental- and physical-therapy programs that enhance individual motivation, according to Penn State engineers.
“We want to understand the human and team behaviors that motivate learning to ultimately develop personalized methods of learning instead of the one-size-fits-all approach that is often taken,” said Conrad Tucker, assistant professor of engineering design and industrial engineering.
They seek to use machine learning to train computers to develop personalized mental or physical therapy regimens — for example, to overcome anxiety or recover from a shoulder injury — so many individuals can each use a tailor-made program.
“Using people to individually evaluate others is not efficient or sustainable in time or human resources and does not scale up well to large numbers of people,” said Tucker. “We need to train computers to read individual people. Gamification explores the idea that different people are motivated by different things.”
To begin creating computer models for therapy programs, the researchers tested how to most effectively make the completion of a physical task into a gamified application by incorporating game features like scoring, avatars, challenges and competition.
“We’re exploring here how gamification could be applied to health and wellness by focusing on physically interactive gamified applications,” said Christian Lopez, graduate student in industrial engineering, who helped conduct the tests using a virtual-reality game environment.
In the virtual-reality tests, researchers asked participants to physically avoid obstacles as they moved through a virtual environment. The game system recorded their actual body positions using motion sensors and then mirrored their movements with an avatar in virtual reality.
Participants had to bend, crouch, raise their arms, and jump to avoid obstacles. The participant successfully avoided a virtual obstacle if no part of their avatar touched the obstacle. If they made contact, the researchers rated the severity of the mistake by how much of the avatar touched the obstacle.
In one of the application designs, participants could earn more points by moving to collect virtual coins, which sometimes made them hit an obstacle.
“As task complexity increases, participants need more motivation to achieve the same level of results,” said Lopez. “No matter how engaging a particular feature is, it needs to move the participant towards completing the objective rather than backtracking or wasting time on a tangential task. Adding more features doesn’t necessarily enhance performance.”
Tucker and Lopez created a predictive algorithm — a mathematical formula to forecast the outcome of an event — that rates the potential usefulness of a game feature. They then tested how well each game feature motivated participants when completing the virtual-reality tasks. They compared their test results to the algorithm’s predictions as a proof of concept and found that the formula correctly anticipated which game features best motivated people in the physically interactive tasks.
The researchers found that gamified applications with a scoring system, the ability to select an avatar, and in-game rewards led to significantly fewer mistakes and higher performance than those with a win-or-lose system, randomized gaming backgrounds and performance-based awards.
Sixty-eight participants tested two designs that differed only by the features used to complete the same set of tasks. Tucker and Lopez published their results in Computers in Human Behavior.
The researchers chose the tested game features from the top-ranked games in the Google Play app store, taking advantage of the features that make the games binge-worthy and re-playable, and then narrowed the selection based on available technology.
Their algorithm next ranked game features by how easily designers could implement them, the physical complexity of using the feature, and the impact of the feature on participant motivation and ability to complete the task. If a game feature is too technologically difficult to incorporate into the game, too physically complex, does not offer enough incentive for added effort or works against the end goal of the game, then the feature has low potential usefulness.
The researchers would also like to use these results to boost workplace performance and personalize virtual-reality classrooms for online education.
“Game culture has already explored and mastered the psychological aspects of games that make them engaging and motivating,” said Tucker. “We want to leverage that knowledge towards the goal of individualized optimization of workplace performance.”
To do this, Tucker and Lopez next want to connect performance with mental state during these gamified physical tasks. Heart rate, electroencephalogram signals and facial expressions will be used as proxies for mood and mental state while completing tasks to connect mood with game features that affect motivation.
The National Science Foundation funded this research.
Muscles are often referred to as ‘motors’ that drive human and animal movements. This analogy certainly captures the important role of muscles as active generators of force and movement. However, it sells the equally important passive properties of muscles short. Most of us will only appreciate the importance of passive muscle properties when these are affected by disease. For instance, people who have had a stroke or children with cerebral palsy frequently develop muscle contractures – a stiffening of muscles even when the muscle is not activated. Contractures frequently lead to loss of mobility, bone deformities and other undesirable effects that limit physical independence.
Aiming to better understand the passive mechanical properties of muscles, we have used diffusion tensor imaging (DTI), a magnetic resonance imaging (MRI) technique, to obtain the most detailed measurements to date of changes in muscle structure of a human calf muscle (medial gastrocnemius) during passive lengthening (Bolsterlee et al., 2017; note that for those interested in more details on this novel imaging technique, there is a recent review paper by Damon et al., 2017). From the DTI data we measured how several thousands of muscle fibres changed length, orientation and curvature when the whole muscle was lengthened. We also measured the change in dimensions of muscle fibres, which can be thought of as several centimeter long cylindrical tubes with diameters similar to human hairs. From anatomical MRI scans the changes in three-dimensional whole-muscle shape were derived.
We found that the medial gastrocnemius reduced both its width and its depth when the muscle lengthened. Muscle fibres rotated by about 8° and lengthened by 35% when the whole muscle changed its length by 7%. The diffusion properties of muscle tissue measured by DTI (which gives information about the microstructure of muscle cells) suggest that the diameter of muscle fibres decreases when fibres are lengthened, presumably to maintain a constant volume.
These data help us understand the complex changes in structure that human muscles undergo when they passively lengthen. We can now use these methods to study, in unprecedented detail, the differences in muscle structure between healthy people and people with muscle contractures. This may give us new insights into the mechanisms of contracture, which will ultimately enable better management or treatment of this condition.
Bolsterlee B, D’Souza A, Gandevia SC, Herbert RD (2017). How does passive lengthening change the architecture of the human medial gastrocnemius muscle? J Appl Physiol, 122(4): 727-738.
Damon BM, Froeling M, Buck AK, Oudeman J, Ding Z, Nederveen AJ, Bush EC, Strijkers GJ (2017). Skeletal muscle diffusion tensor-MRI fiber tracking: rationale, data acquisition and analysis methods, applications and future directions. Nmr Biomed 30. DOI: 10.1002/nbm.3563.
Scientists used to believe that the brain stopped making new brain cells past a certain age. But that believe changed in the late 1990’s as a result of several studies which were performed on mice at the Salk Institute.
After conducting maze tests, neuroscientist Fred H. Gage and his colleagues examined brain samples collected from mice. What they found challenged long standing believes held about neurogenesis, or the creation of new neurons.
To their astonishment, they discovered that the mice were creating new neurons. Their brains were regenerating themselves.
All of the mice showed evidence of neurogenesis but the brains of the athletic mice showed even more.
These mice, the ones that scampered on running wheels, were producing two to three times as many new neurons as the mice that didn’t exercise.
The difference between the mice who performed well on the maze tests and those that floundered was exercise.
That’s great for the mice, but what about humans?
To find out if neurogensis occurred in adult humans, Gage and his colleagues obtained brain tissue from deceased cancer patients who had donated their bodies to research. While still living, these people were injected with the same type of compound used on Gage’s mice to detect new neuron growth. When Gage dyed their brain samples, he saw new neurons. Like in the mice study, they found evidence of neurogenesis – the growth of new brain cells.
From the mice study, it appears that those who exercise produce even more new brain cells than those who don’t. Several studies on humans seem to suggest the same thing.
Studies performed at both the University of Illinois at Urbana- Champaign and Columbia University in New York City have shown that exercise benefits brain function. The test subjects were given aerobic exercises such as walking for at least one hour three times a week. After 6 months they showed significant improvements in memory as measured by a word-recall test. Using fMRI scans they also showed increases in blood flow to the hippocampus (part of the brain associated with memory and learning). Scientists suspect that the blood pumping into that part of the brain was helping to produce fresh neurons.
Dr. Patricia A. Boyle and her colleagues of Rush Alzheimer’s Disease Center in Chicago found that the greater a person’s muscle strength, the lower their likelihood of being diagnosed with Alzheimer’s. The same was true for the loss of mental function that often precedes full-blown Alzheimer’s.
Neuroscientist Gage, by the way, exercises just about every day, as do most colleagues in his field. As Scott Small a neurologist at Columbia explains,
I constantly get asked at cocktail parties what someone can do to protect their mental functioning. I tell them, ‘Put down that glass and go for a run.
So if you want to grow some new brain cells and improve your brain function, go get some exercise!