[ARTICLE] Effects of Transcranial Direct Current Stimulation Combined With Physical Training on the Excitability of the Motor Cortex, Physical Performance, and Motor Learning: A Systematic Review – Full Text
Purpose: This systematic review aims to examine the efficacy of transcranial direct current stimulation (tDCS) combined with physical training on the excitability of the motor cortex, physical performance, and motor learning.
Methods: A systematic search was performed on PubMed, Web of Science, and EBSCO databases for relevant research published from inception to August 2020. Eligible studies included those that used a randomized controlled design and reported the effects of tDCS combined with physical training to improve motor-evoked potential (MEP), dynamic posture stability index (DPSI), reaction time, and error rate on participants without nervous system diseases. The risk of bias was assessed by the Cochrane risk of bias assessment tool.
Results: Twenty-four of an initial yield of 768 studies met the eligibility criteria. The risk of bias was considered low. Results showed that anodal tDCS combined with physical training can significantly increase MEP amplitude, decrease DPSI, increase muscle strength, and decrease reaction time and error rate in motor learning tasks. Moreover, the gain effect is significantly greater than sham tDCS combined with physical training.
Conclusion: tDCS combined with physical training can effectively improve the excitability of the motor cortex, physical performance, and motor learning. The reported results encourage further research to understand further the synergistic effects of tDCS combined with physical training.
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that modulates the neural activities of cortical brain regions by applying a constant weak current (e.g., current intensity of one electrode is usually smaller than 2 mA) via the scalp electrodes (Nitsche and Paulus, 2000). More and more research using tDCS has emerged in the fields of sports and rehabilitative medicine these days (Chang et al., 2017; Xiao et al., 2020). Two types of tDCS are commonly used, that is, anodal tDCS (a-tDCS) aiming to increase the excitability of the targeting cortical regions by depolarizing the resting membrane potentials of neurons, and cathodal tDCS (c-tDCS) that often induces inhibitory effects of neural excitability in the targeted brain regions (Nitsche and Paulus, 2000, 2001; Bastani and Jaberzadeh, 2012). Recent studies in the field of sports sciences have shown that using tDCS can significantly enhance physical performance, such as the toe abduction strength (Tanaka et al., 2009) and reaction time (Tseng et al., 2020) in healthy people and the knee extensor force in patients with hemiparetic stroke. Several previous systematic reviews have also confirmed that using tDCS can induce benefits to important functionalities, such as motor control, in different populations (e.g., people with Parkinson’s disease (PD) (Broeder et al., 2015) and healthy cohorts (Machado et al., 2019).
More recently, researchers have started to combine tDCS with other types of interventions, such as physical (e.g., exercise, physiotherapy, etc.) and cognitive training (Beretta et al., 2020), and explore the effects of this mixed type of intervention. Studies have shown that both tDCS and exercise (e.g., strength training) can increase the excitability of cortical (e.g., primary motor cortex, M1) as measured by the amplitude of motor-evoked potential (MEP) (Kidgell et al., 2010; Mazzoleni et al., 2019). Therefore, it is speculated that this mixed-type intervention may induce greater improvements as compared to tDCS-or exercise/training-only intervention. However, a large variance in the results of the studies exploring the effects of such mixed-type intervention was observed in previous studies. For example, Kim and Ko (2013) observed that tDCS combined with grip strength training induced a greater increase in MEP amplitude as compared to tDCS applied alone, and Jafarzadeh et al. (2019) also observed that tDCS combined with physical training induced greater improvement in dynamic stability. However, Zandvliet et al. (2018) reported that in healthy people, tDCS combined with posture training did not induce significant improvement in the center of pressure (CoP) parameters when standing quietly with eyes open or closed, including the mean and variability of the amplitude of the CoP displacement and the mean and variability of the velocity of CoP fluctuation.
Therefore, the effects of this mixed-type intervention consisting of tDCS with physical training remain unclear due to the inconsistent results of previous publications. This systematic review here thus aims to examine the efficacy of tDCS combined with physical training on the excitability of M1, physical performance and motor learning function in populations without any major neurological diseases by critically evaluating and comparing the results in the publications, which will ultimately provide important knowledge to this field and informing the design of future studies.[…]
There are Plants that Improve Memory and Concentration, and using them can keep your brain healthy and enhance cognitive functioning.
Huperzine-A is a compound that is usually derived from the extracts of Huperzia serrata, also known as firmoss. The plant is native to the parts of China and Southeast Asia.
The compound-huperzine A is commonly used as a memory enhancer because it affects the neurotransmitters and, in turn, promotes healthy growth of the brain.
It also helps with Alzheimer’s disease and vascular dementia. Read more about it here!
Choline is a nutrient present in most types of beans. It boosts the healthy metabolism and fosters the creation of neurotransmitters in the brain. Also, choline prevents the decline of the cognition actions of the mind. You can steam the beans and eat them with a pinch of salt for a maximum benefit.
Already, beans are one of the richest vegan protein sources; it’s worthy of adding them in your regular diet.
3. Ginkgo Biloba
Ginkgo biloba is used for many cognitive benefits since time immemorial. Furthermore, this powerful medicinal herb may regenerate and heal the brain cells, promoting attention, memory, and intelligence. Besides improving mental health, Ginkgo Biloba has many other health benefits too.
However, be careful while using this herb if you’re on certain medications. Get help from here if you would like to grow a ginkgo biloba tree in your garden.
Having the highest densities of nutrients, kale is a great natural source to maintain good mental health. It consists of the well-known brain supporting fatty acids–Omega-3. There’s also a presence of a plant pigment known as Lutein, which enhances the learning and memory power.
There are numerous ways to consume kale: You can add it to your salads or prepare different recipes with it.
Also Read: Best Salad Greens for Container Gardeners
You can’t skip on rosemary, one of the best herbs for memory recall. This herb has long been used for aromatherapy as a memory booster, especially in the form of essential oil. Rosemary essential oil is known to promote memory retention, concentration, and efficiency in mental tasks. When taken by mouth, it proves to be an excellent antioxidant to strike against the free-radicals.
This popular herb often increases the level of antioxidants and some healthy fats like Omega-3 in your brain. However, not much is known about the relation between thyme and memory, but researchers believe it to have some rare positive effects on your brain cells.
It is rich in luteolin, which is a flavonoid with antioxidant properties. You can add it to your recipes or make thyme tea.
Also Read: 13 Easy to Grow Herbs
Peppermint has multiple health benefits; it improves your learning abilities and creative mind. The smell of this herb has proved its powers of having positive effects in cognition and mood in much scientific research.
Researchers often claim that infusing your room with the fragrance of peppermint oil can induce a high level of energy while increasing your alertness and memory function. It is an easy to grow herb and has many culinary uses.
Also Read: Amazing Peppermint Oil Uses for Gardeners
8. Bacopa Monnieri
Bacopa Monnieri is an Ayurvedic herb, which is also known as Brahmi. It lowers inflammation and reduces beta-amyloid in the brain and can also help people with Alzheimer’s or anxiety issues. It’s a great source to maintain a mind free of stress and anxiety, thereby increasing your mental health.
You can consume this herb in the form of a tonic liquid or combine it with your dishes. Check out this study for validation.
Also Read: DO all these things Before 7 AM for Beautiful Garden
Ashwagandha is commonly used to treat nervous exhaustion and prevent the depletion of brain cells. This traditional Ayurvedic medicine helps you to establish a mental clarity and enhance cognitive performances.
Besides this, it also boosts the immune system and reproductive functioning. Learn how to grow it here.
10. Sweet Flag (Vacha)
Vacha is a medicinal herb, commonly used to help people with nervous system disorders. It has a powerful impact on people with low mood as it works great as a stimulant. It possibly helps to detoxify the brain and improve its functioning, which further aids in mental concentration and remembrance power.
11. Gotu Kola
Asian Pennywort, also known as Gotu kola, comes from the parts of India, interestingly, it is called Brahmi as well. However, this article here chalks out the difference between the plant above and this well. It considerably enhances blood circulation in mind and supports memory power. Being an adaptogen, it can lower down the stress level, which results in improved memory.
12. Reishi Mushroom
Reishi Mushroom, being a medicinal plant, helps you with many health complications. One of which is anxiety and depression. Stress and anxiety tend to disturb the normal functioning of the brain, making it difficult to think clearly and memorize. While reishi can’t directly strike these issues, it may ease down some of the symptoms.
You can take Reishi mushroom supplements in any form, solid or liquid! Check out this Michigan University article to learn about this famous Japanese fungus.
13. Holy Basil
Holy Basil or tulsi increases the supply of oxygen in mind and improves blood circulation. It can also be used to cure depression and overall cognitive functioning. You can either take it raw with some amount of water or add it in your salads or other dishes or make a basil tea.
Also Read: 18 Types of Basil Varieties for Gardeners
Ginseng increases overall mental health by improving vitality. Researchers state that ginseng activates neurotransmitter activities and therefore boosts memory. Moreover, it prevents the brain cells from toxins and maintains a better functioning within the body and the brain.
Learn how to grow ginseng in your garden here.
Periwinkle improves blood and oxygen circulation in your brain to allow your mind to perform well. It has vincamine that is a common ingredient these days in medications for Alzheimer’s and Dementia. It’s a powerful striking agent against free radicals and prevents possible damage to the blood vessels. By supplying more nutrients to the brain, periwinkle can help the brain to function well towards storing and memorizing things.
Both the periwinkles (Vinca minor and Vinca major) are used for medicinal purposes. Learn how to use it here.
The compounds present in blueberries can improve decision-making power, verbal comprehension, memory, and reasoning ability. Regular consumption of blueberries can protect a person from getting affected by Alzheimer’s and dementia.
According to this research, drinking blueberry juice can improve brain function in older people.
17. Yerba Maté
Yerba Mate is a shrub that most of the people use to ease depression and enhance concentration. Also, this medicinal shrub has shown positive impacts on short-term memory problems.
Along with this, its consumption in the form of tea can help in mindful relaxation and improved learning abilities. Visit Healthline to see more Yerba Mate benefits.
The optimal period for intensive rehabilitation of arm and hand use after a stroke should begin 60 to 90 days after the event, according to a phase II, randomized clinical trial. The study, conducted by Georgetown University and MedStar National Rehabilitation Network (NRH) researchers, was published in PNAS.
The same intensive rehabilitation at less than 30 days after a stroke provided some benefit, but rehabilitation at 6 months or more after a stroke showed no significant benefit compared to those receiving standard care.
Nearly two-thirds of people who have a stroke do not recover complete function in their hands and arms, an impairment that can severely limit everyday activities, a media release from Georgetown University Medical Center notes.
“Our finding demonstrates the existence of a critical period or optimal time when adults are most responsive to rehabilitation after a stroke. Previous clinical trials have found few or very small improvements in motor function post-stroke, so our research could be an important breakthrough in finding ways we can make substantial improvements in arm and hand recovery.”
— lead author Alexander Dromerick, MD, professor of Rehabilitation Medicine and Neurology and chair of Rehabilitation Medicine at Georgetown University Medical Center and vice president for research at MedStar NRH
For their trial, the clinicians enrolled 72 stroke participants, primarily from the Washington, DC area, within 3 weeks after their stroke. The participants were randomly assigned to receive 20 extra hours of activity-focused motor skills therapy, starting at different times after stroke, in addition to their regularly prescribed therapies.
The additional therapy began either at 30 days after their stroke, at 60 to 90 days post-stroke, or at 6 months or more post-stroke. The results were compared to a control group that received only their prescribed rehabilitation therapies but no extra motor rehabilitation training.
“Our results suggest that more intensive motor rehabilitation should be provided to stroke patients at 60 to 90 days after stroke onset. It is well known that a young developing brain shows great plasticity, compared to other times in life. Our results show that there may be a similar period of heightened plasticity for stroke patients at a specific time after their stroke.”
— Elissa Newport, PhD, director of the Center for Brain Plasticity and Recovery at Georgetown University Medical Center and corresponding author of this article
Functionally Meaningful Difference
The improvement in hand and arm function found in this study was not only statistically significant, it was large enough to be perceived as functionally meaningful by the patients themselves.
“Our approach shows that patients can tolerate much more intensive motor training than is traditionally provided if they are free to choose the activities used in their training. Knowing there might be a critical period for recovery, there are many techniques one might imagine bringing to bear on understanding and enhancing recovery during this time period.”
— Dorothy F. Edwards, PhD, professor of Kinesiology and Medicine at the University of Wisconsin-Madison and member of the Center for Brain Plasticity and Recovery
The researchers hope that this study will establish a time window in which future research can combine therapy with brain stimulation or medications aimed at helping remaining healthy areas of the brain recover impaired functions or take over functions lost from the damage inflicted by a stroke.
The investigators also plan to design a larger clinical trial to confirm the current findings and to determine the optimum dose of therapy, thereby achieving the best effects during this time-sensitive window, the release concludes.
[Source(s): Georgetown University Medical Center, Science Daily]
Health startup Evolution Devices has created an AI-based platform called EvoWalk that stimulates nerves to help muscle-impaired people walk again.
The platform blends remote physical therapy with connected smart stimulation devices to help people such as cerebral palsy patients or stroke victims to rehabilitate and start walking again.
The company is launching a pilot program today to rehabilitate people living with neurologically based partial walking paralysis. It is also raising funds via a crowdfunding program.
Pierluigi Mantovani, CEO of Evolution Devices, said in an interview with VentureBeat that he started working on the platform in 2017 as part of an effort to help his father deal with the effects of multiple sclerosis.
After his father was diagnosed with MS, he struggled to walk and he suffered some falls because he dragged his foot while walking. Mantovani was at the University of California at San Francisco doing work on neurostimulation, or electrical stimulation of nerves. His team built a first prototype and have spent years refining it.
“My dad has multiple sclerosis. He developed a walking problem pretty shortly after he had MS,” Mantovani said. “So my cofounders and I ended up building our first prototype to help him pick up his foot while he walks so that he would stop tripping.”
Mantovani started working on a virtual physical therapy platform paired with an AI-informed nerve stimulation wearable called the EvoWalk.
“We have a vision of having a more data-driven approach to physical therapy and rehabilitation,” Mantovani said. “We started helping people specifically with neurologic impairments, like my dad has, but also for those who had strokes or spinal cord injuries.”
People who’ve experienced neurological conditions such as strokes, MS, or Parkinson’s tend to drag their affected foot, but the EvoWalk uses machine learning to bypass the nerve and lift the foot at just the right time to help users avoid falls and walk more freely. Machine learning helps to learn the different walking styles of people and adjusts the stimulation of the nerves with electricity.
The goal is to help patients reclaim their lost instinctual movement.
Fighting foot drop
Above: Fighting foot drop.Image Credit: Evolution Devices
Evolution Devices is initially focused on rehabilitating foot drop, an impairment where a person is unable to lift their foot due to muscle weakness or nerve damage and which frequently causes falls. Mantovani believes there are around four million people with the problem.
“There are over 36 million people who fall at least once a year, and it’s costing the U.S. health system about $15 billion,” he said.
Foot drop generally results from a stroke or MS. The EvoWalk remote therapy platform allows these patients to meet with physical therapists (PTs) virtually, providing them with a personalized and comprehensive rehab program to help them improve their mobility.
Evolution Devices is currently conducting a pilot of the EvoWalk Platform through Lisa Donahue, the company’s director of clinical services and a neuro physical therapist. In addition, researchers at the University of California at San Francisco are running an EvoWalk clinical study.
Earlier pilot studies of the EvoWalk Platform revealed that patients experienced up to a tenfold increase in their walking activity and improved their walking speed in as little as eight weeks.
How it works
Above: The EvoWalk deviceImage Credit: Evolution Devices
With the EvoWalk Platform, a patient is matched with a certified neurologic PT who assesses them remotely via a secure, HIPAA-compliant video platform.
The patient receives the EvoWalk device and downloads the patient app. Dedicated PTs train the patient on the EvoWalk and develop a customized therapy program that evolves as their rehab progresses.
While wearing the EvoWalk device, the patient walks more freely as it provides personalized stimulation that lifts the patient’s foot at precisely the right times. Mobility data is automatically collected and shared with the patient and therapist and is used to refine their rehab therapy.
“Since we are collecting this data while they are wearing it, we can measure how much they’re improving, like how much a knee is bending,” Mantovani said. “Over time, we can show their speed is getting better. We have a patient-facing app where patients can see their data.”
The EvoWalk device
Patients wear the EvoWalk device around the leg just below the knee. It provides functional electrical
stimulation (FES) therapy to help patients to pick up their foot and walk more smoothly. By applying electrical stimulation to the lower leg, EvoWalk acts as an artificial nerve that bypasses the non-functioning nerve responsible for lifting the foot and toes.
The device’s built-in sensors feed real-time motion data to AI algorithms and provide actionable metrics through connected patient and clinician mobile apps, driving patient engagement.
The patient app empowers patients by making it easy to monitor daily progress of key metrics, while the clinician app provides more detailed insights that enable PTs to remotely assess and refine their tailored rehab interventions.
One early EvoWalk user, a hemiplegic stroke survivor with foot drop, finished a 5K walk in just over an hour, shattering his goal of 90 minutes for completing the race.
Evolution Devices has raised more than $1 million in funding from notable investors including the Alchemist Accelerator and Edge Systems founder Bill Cohen.
In addition, the company has won grants from such organizations as the Toyota Mobility Foundation, Bristol Myers Squibb and Lyfebulb, the National Science Foundation, and the National Institutes of Health.
Above: Evolution Devices is measuring data on “foot drop.”Image Credit: Evolution Devices
“The device tracks people’s movement over time. So they wear it every day,” Mantovani said. “It works as a therapeutic because of the stimulation. So people want to wear it. And then we get really detailed data, which helps us know how to move forward with physical therapy.”
The company’s goal is to launch in the second quarter of next year, but to do that the device will need clearance from the U.S. Food and Drug Administration as a physical therapy platform.
Mantovani’s father is still using the device.
“He uses it pretty much every day. And every time we have a new version, he’s the first person to test it, which is nice because he can break it first before we give it to anyone else,” Mantovani said. “This is one of our hardest problems, and it really helps to have a physical therapist help someone like my dad who has a progressive version of multiple sclerosis. This can help slow the progression.”[…]
[ARTICLE] HoMEcare aRm rehabiLItatioN (MERLIN): preliminary evidence of long term effects of telerehabilitation using an unactuated training device on upper limb function after stroke – Full Text
While short term effects on upper limb function of stroke patients after training with robotic devices have been studied extensively, long term effects are often not addressed. HoMEcare aRm rehabiLItatioN (MERLIN) is a combination of an unactuated training device using serious games and a telerehabilitation platform in the patient’s home situation. Short term effects showed that upper limb function improved after training with MERLIN. The aim was to determine long term effects on upper limb function and quality of life.
Six months after cessation of the 6 week MERLIN training program, the upper limb function and quality of life of 11 chronic stroke patients were assessed. Upper limb function was measured using the Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Fugl-Meyer Assessment-Upper Extremity (FMA-UE). EuroQoL-5D (EQ-5D) was used to measure quality of life.
The WMFT, ARAT and EQ-5D did not show significant differences 6 months after the training period compared to directly after training. At 6 months follow-up, FMA-UE results were significantly better than at baseline. Time plots showed a decreasing trend in all tests.
Training effects were still present at 6 months follow-up, since arm function seemed similar to directly after training and FMA-UE results were better than at baseline. However, because of the decreasing trend shown in all tests, it is questionable if improvements will be maintained longer than 6 months. Due to the sample size and study design, results should be interpreted with caution.
The majority of people who suffered a stroke have persistent problems with using the arm or hand in daily life, with estimates between 62 and 88% [1, 2]. After a severe paresis, only 7–18% regains full function of the upper limb [1, 3]. Actual numbers might be less drastic since these studies are rather dated and specific groups of severely affected stroke patients were investigated. Nevertheless, the latest insights show that improvement of the upper limb function is possible even 1 year after stroke onset [4, 5]. More training possibilities have become available for patients in the chronic phase of stroke. Patients with a better upper limb function may be more independent and less reliant on their caregivers, which is important for a stroke survivor . An improved arm function could also lead to more use of the arm in daily life which in turn is beneficial for further recovery. Additionally, independence of the patient may unburden the health care system due to a lower need for care and adaptations at home or a reduction in the need for long term therapy. More frequent, intensive or longer training programs have been positively correlated with improvement in upper limb function . Many patients would like to receive more training than they are currently offered, unfortunately this is not possible in all instances due to limited healthcare resources . The search for alternative ways to provide therapy is on-going.
A promising solution is to use (robotic) devices to train the upper limb using serious games. Several reviews revealed that robotic training is safe and can provide more intensive training than in standard care situations, especially in the chronic phase [8,9,10]. Robotic training devices seem to improve the upper limb function directly after training [11, 12]. While these are only short term effects, equally important is to know whether training with these devices results in long lasting improvements. In only one review the follow-up after training was described, and the authors concluded that there was no significant difference between a robotic training group and the conventional group when matched for training intensity . This conclusion was based on a meta-analysis using data from only three papers in which two investigated a robotic device and one a non-robotic device [8, 13,14,15]. Evidently, insufficient information is yet available on the long term effects of training with (non)robotic devices.
We investigated the long term effect of hoMEcare aRm rehabiLItatioN (MERLIN), an unactuated (non-robotic) training device combined with a telecare platform to train the arm and hand at home (see Fig. 1). The short term results of MERLIN showed that moderately affected patients in the chronic phase of stroke were able to achieve a statistically significant as well as a clinically relevant improvement in upper limb function . The improvements were retained at least 6 weeks after termination of the training. We expected patients to use the affected arm more in daily life after the intervention due to an improved arm function. Some evidence suggests that after intense therapy, patients are able to use the hand more during different activities with effects lasting up to 1 year [17, 18]. Therefore we hypothesized that upper limb function would improve between cessation of the intervention and 6 months after the intervention. The aim of this study was to assess upper limb function and quality of life in patients in the chronic phase after stroke, who trained with MERLIN at home 6 months prior to the assessment. First we will discuss the difference between our findings directly after the training and the findings at 6 months follow-up. Thereafter, we compare the 6 month follow-up data to the data of all previous measurements.
Flipping the script to aid in recovery
By Dr. Tatiana Habanova, DC, DACNB
For many, especially those with a brain injury, brain fog is like that uninvited guest who makes themselves way too comfortable at the dinner table. And once settled in, getting rid of them can be very difficult. Brain fog begins to take over the way you feel, how you think, and slowly separates you from the very fabric you called your life. By altering your cognitive functions like focus, attention, concentration, information processing speed, and initiation, you are eventually at the mercy of its subtle, but consistent influence and begin unconsciously adjusting your life to accommodate this unwanted guest, all the while not realizing your very essence is slowly slipping away.
Brain fog shows up differently in everyone. Just like snowflakes, no two are alike. For some, brain fog is transitory and mild. It comes and goes. For example, if one had one too many drinks the night before and woke up “hung over,” that’s the effect of brain fog. With adequate rest, hydration and time, the feeling of a fuzzy brain goes away. The same holds true for gluten, dairy, and other potential food items one has become “sensitive” to. Once the system is exposed to a trigger (i.e.: toxin or food item), a metabolic cascade occurs, leaving one feeling as if their head is in the clouds.
For others, brain fog is more a constant experience of haze ranging from mild to severe. It just always seems to be there. In addition to the cognitive symptoms, one can also have memory issues, light and sound sensitivity, blurry vision and eye strain, and vestibular symptoms, just to name a few. Essentially, this type of brain fog is due to the neurons (brain cells) being less stable/fit to function at the capacity they are being asked to do. For example, if one is reading, the brain must control both eyes to move in exactly the same speed, the same distance along the page, and in a coordinated fashion so accurate eye movements occur, and one does not experience blurry vision. If the nerves that control the eye muscles are unable to perform at peak state, then errors with smooth coordinated eye movements cause one to become tired (brain-based fatigue), as well as experience difficulty with reading, short term memory, and spatial awareness.
Now, let’s get to the root cause of neurologically-based brain fog.
In order for neurons to work efficiently, they need three essential nutrients. Often, this is referred to as the three Neuro Necessities. First, each neuron requires a constant supply of oxygen. The brain utilizes up to 20% of the oxygen carried in the blood and 50% when thinking hard, being creative, or under stress. Shallow breathing with minimal rib cage expansion is an indicator the quality of breath is less than ideal. To demonstrate the power of breath, take a few deep, slow, prolonged breaths in and out, and then notice if you suddenly become more alert and aware.
Second, a constant source of fuel, preferably in the form of fats and carbohydrates, is required as the brain never stops working (even when you are sleeping). Many people, unknowingly, create the effects of brain fog by not eating a balanced healthy diet, skipping meals, or ignoring underlying sugar handling issues (i.e.: insulin resistance, metabolic syndrome, etc.), which hinders the availability of glucose to brain cells.
Lastly, each neuron requires appropriate stimulation (not too much and not too little — I call this the “Golidlocks Rule”). This is essential for neurological pathways to be maintained and kept viable, just like a well-walked path doesn’t allow the weeds to grow on it. When the demand placed on the neuron is greater than it can cope with, the neuron begins to undergo a slow neurodegenerative process, which leads to a slow spiraling decline in cognitive functions.
An important note: Multiple brain fog-producing mechanisms can be occurring simultaneously to create a chronic state that waxes and wanes. For example, someone can have a food intolerance (i.e.: gluten, dairy, soy) which produces an inflammatory event, which affects brain cell function, plus they may not have enough or too much neurological stimulation to a pathway causing it to undergo transneuronal degeneration (TND).
By understanding the various mechanisms that produce brain fog, assembling a plan of action to turn brain fog into boosted brain function is easier. Focusing on the three Neuro Necessities is the foundational step for this process. Working with a trained professional who can properly assess brain function, and then create a care plan that can be properly executed is extremely valuable in overcoming brain fog.
Dr. Habanova is the host of Brain Health Savvy, a weekly podcast that inspires listeners through real conversations on all things pertaining to women’s brain health. She transforms women in simple, yet real ways. Her sass, wit, and straight-from-the-hip style on women’s brain health and empowerment encourages women to seek their true potential, to be fierce and unapologetic while leading from authenticity, and to embracechange as they buck societal norms in favor of better brain health.
If you have epilepsy, you may be curious about the role vitamin D plays in terms of seizure activity. As one MyEpilepsyTeam member asked, “Does anyone use vitamins like vitamin D to control seizures?” Another said, “Is anyone taking vitamins? What kind do you think is best?”
It’s important to understand whether there are any connections between vitamin D intake and epilepsy symptoms and if you should do anything to evaluate whether you have enough vitamin D in your diet.
What Is Vitamin D?
Vitamin D is a nutrient that your body needs to make your muscles move, help your nerves send signals, and allow your immune system to fight off bacteria and viruses that can make you sick. Vitamin D is also important so bones can absorb the calcium they need to be strong and healthy.
There are two kinds of vitamin D: vitamin D2 and vitamin D3. Vitamin D2 is mostly found in plants, mushrooms, and yeast. Vitamin D3 can be found in oily fish and is also made in the body during sun exposure. Additionally, vitamin D3 is later converted to 25-hydroxy-cholecalciferol, which helps turn on and off the genes that allow vitamin D to carry out its function in the body.
According to the Cleveland Clinic, foods that are good sources of vitamin D include:
- Beef liver
- Fortified cereal
- Fish (such as salmon, sardines, swordfish, and cod liver oil)
- Egg yolks
- Fortified milk and orange juice
Your body breaks vitamin D down into its active form, called 1,25-dihydroxyvitamin D — which is also known as calcitriol and can be found as a supplement. This active form of vitamin D can affect the cells involved in the immune system.
Vitamin D Levels in People With Epilepsy
People with epilepsy are often curious about the effects of vitamin D on seizure disorders and other neurological conditions.
According to a 2016 study, vitamin D is important for many aspects of brain development, including cell growth, cell differentiation, and neuroprotection. Vitamin D3, for example, corresponds to specific vitamin D receptors and enzymes in the central and peripheral nervous systems. People with epilepsy often do not have enough vitamin D3, the study authors wrote.
Researchers have also found that vitamin D levels can drop as a result of drug therapy for epilepsy, despite the medications’ positive anticonvulsant effects. Many people who take antiepileptic drugs (AEDs) are vitamin D-deficient, potentially because some anti-seizure medications disrupt how the body processes vitamin D.
Additionally, there is a high prevalence of osteoporosis in people with epilepsy, potentially because of vitamin D3 deficiency. Some AEDs reduce levels of this vitamin as a side effect. Research of people with epilepsy found these individuals face a sixfold risk for bone fracture compared with the normal population. This finding is likely due to frequent falls, reduced bone density, and low levels of vitamin D3.
Other potential dangers can come with vitamin D insufficiency. For example, sudden unexpected death in epilepsy (SUDEP) may be linked to cardiovascular health. A 2010 study found that sudden cardiac death was twice as high for those with vitamin D levels below 20 ng/dL compared to individuals with levels above 20 ng/dL.
Does Vitamin D Supplementation Help Reduce Seizures?
Research has shown that vitamin D supplementation may help reduce seizures in people with epilepsy. One 2012 study found that increasing vitamin D intake helped reduce seizures in people with epilepsy by a median of 40 percent.
Vitamin D may help protect against seizures because it upregulates anticonvulsant growth factors, such as neurotrophic factors. These are molecules that enhance the growth and survival potential of neurons. In other words, vitamin D helps strengthen the anticonvulsive effects of molecules within your body.
Although many previous studies have shown promising results, neurology researchers emphasize the importance of further clinical trials to investigate the effectiveness of vitamin D on people with epilepsy.
Talk to your health care team if you’re considering adding vitamin D supplements to your diet. Data suggests that taking vitamin D supplements can be helpful for people with epilepsy, but you can also run the risk of taking too much.
The Office of Dietary Supplements warns that too much vitamin D can cause nausea and vomiting, muscle weakness, confusion, pain, dehydration, and kidney stones, among other side effects. Vitamin D can also interact with some medications, so don’t start any supplementation plan before speaking with your physician.
Talk With People Who Understand
On MyEpilepsyTeam, the social network and online support group for people with epilepsy and their loved ones, members discuss the chronic nature of the disease. Here, more than 96,000 members from across the world come together to ask questions, offer advice and support, and share stories with others who understand life with epilepsy.
Are you using vitamin D to help with epilepsy symptoms? Share your experience in the comments below, or start a conversation on MyEpilepsyTeam.
Because scientific data should be accessible to everyone.
Wouldn’t it be great if scientific papers were written so that everyone could understand them? We could refer to factual scientific data when someone makes a false claim, or we could use scientific papers to sort out fake news. Unfortunately, reading a scientific paper is not the same as reading a news article or blog post. They are confusing and hard to read, even scientists need to go through a lot of training to be able to read papers effectively, but this guide will make them easier to read.
If you just want to quickly scan a paper without diving deep into the study, I recommend you start with reading the abstract to get a brief summary of the study, then look through the figures and look at the data, and then the discussion/conclusion.
If you want to take a deeper look at the paper to understand the study, here’s a simple guide for how to read scientific papers for the non-scientist:
Start with the Abstract
Don’t just read the abstract and ignore the rest of the paper. The abstract is great because it will provide you with a summary of the whole paper, but it probably won’t give you all the information you need. Skim it to get an idea of what you’re about to read and move on.
Read the Introduction
This part is usually easier to read because it is written like a story. It gives some background information on the topic and will sometimes include other studies that are similar to the one you’re reading so you can find more info on the subject. The most important thing about the introduction is that it explains the purpose and importance of the study. After reading the introduction, you should be able to summarize why the scientist is studying this particular topic and what they are trying to find out.
The most important thing to look at here is the sample size and diversity. Would you trust a drug that was shown to work in 10 people or 10,000 people? A study done on 10,000 people will produce more accurate results than a study done on 10 people. It’s hard to be able to draw a conclusion from a limited sample, so make sure the study you’re looking at is using has a large sample size.
Skip it for now and come back . This section is for laying out all the data, but personally I like reading the explanation of the data in the discussion/conclusion first because it’s written in a way that’s easier to understand. After I read the discussion/conclusion, I’ll come back to the results and look at the figures to make sure it all makes sense.
In my opinion, this is the most important section. Just be careful what you read because this section typically includes the researchers opinion on the data. This isn’t necessarily a bad thing, but always go back and check to make sure the results match what the researcher is saying because sometimes people will exaggerate the results to help support their claims. This section is also important because the scientist might tell you about any errors that occurred in the study and whether or not more research is needed to confirm the results.
Back to the Results..
When looking at the figures, it’s important to take a look at error bars. A graph typically represents the average value of all the data collected. The error bars will show you how far the data points were from the average. A small error bar indicates that most of the data points were close to the average value and a large error bar means some of the data points were very different from the average value.
Look at the graph below. At first glance, it seems that participants who did not take medication experienced greater pain than those who took medication. However, if you look at the error bars (the thin black vertical lines sticking out of the middle of the bars), you’ll notice that they are pretty long and overlap with each other. The overlap between the error bars means the data values were similar between the two groups. This indicates the data may not be significant and patients could have experienced no change or little change in pain after taking medication.
The graph below shows no overlap between the error bars. This means the results are most likely significant and the medication probably helped with pain levels.
Don’t be afraid to go back and read the paper again
Science papers are REALLY hard to read so don’t be discouraged if you read through it once and still don’t understand, you might need to read through a few times to fully understand it. Go back, read it again, and identify any questions you may have and where you are getting confused. Google any technical jargon you don’t understand.
It is important that not only everyone has access to scientific data, but that they are able to understand it. Most scientific information is communicated through news articles by journalists who may not be trained in science. Being able to look into their sources and read through the scientific literature is important for sorting out fake news. Check out my article about it here:
Let me know if this guide helped you at all, I’d love to hear your feedback!
Corinne, Biochemist. Writer. Health & Wellness.
David A. Grant, TBI Survivor August 1, 2021
Next month a significant milestone in my life will come to pass as I turn 60 years old. I sustained my traumatic brain injury at the age of 49, when I was run over by a newly licensed teenaged driver on Main Street in my New Hampshire town. I have lived the entire decade of my fifties as a brain injury survivor.
As my 60th birthday approaches, the internal emotions are ramping up. When I was younger, someone 60 was really old. This is not the case any longer. I still cycle an hour or so every day without exception. I’m hovering within a few pounds of my high school weight, and my grey hairs are outnumbered by brown by over a hundred to one.
Over the years, I’ve heard the saying that health is one of those things you never fully appreciate until it’s gone. While this is definitely true, most often it’s used in reference to physical health. But what happens when your mental health is compromised? While we have made great strides in acknowledging the mental health epidemic that surrounds us, like brain injury, there are still societal stigmas that surround mental illness.
The pandemic has acted like Miracle-Gro for many who have mental health challenges. For as much as I wish that I was exempt, I have been pushed to the brink of mental health unwellness a couple of times since our world changed so drastically.
The first time was in the fall of 2020. The daily stress of living under the cloak of the pandemic had taken its toll on me. The endless drumbeat of mainstream media announcing deaths that measured in the hundreds of thousands literally brought me to tears. There was no vaccine available, and all felt dark. As most of 2020 is a blur, I am unable to tell you whether it was in September or October of last year that I hit an emotional bottom, but I can tell you what I felt.
“I just can’t do this anymore,” my mind screamed at me for a few weeks. If I see one more Target or Walmart delivery person at my front door, I’m going to go out of my mind. Think I am being overly dramatic? Think again.
I wanted to get off the pandemic bus. There was no suicidal ideation, no desire to exit life’s stage. That would come later. Rather, I was just weary of it all—wearier than I had ever been in my life. Weariness exacerbated my brain injury challenges, and it became difficult just being me. I felt like I had taken a half-decade step backwards in my recovery.
But it passed.
Round two of my own mental struggles occurred just last month. A few back-to-back nights with horrific PTSD nightmares took its toll on me. At one point—sleep deprived, brain-injured, and utterly exhausted—I had one of my toughest post-TBI days. It was a dark day of stunning magnitude. For a very brief moment, I almost bought into the lie … the lie that things would always be dark and that I was destined to a life of forever struggles. It became too much to even think about. In my mind flicked the dreadful thought that I could no longer take it, that it was all too much, and that I wanted to get off this planet. I had had enough.
The very thought of living for a few more decades, forever tormented by a damaged brain and a life-long path of PTSD, seemed simply too much to bear. In that moment of despair, I lost all perspective.
I find it hard to even admit this out loud. As I pen my experience, I wonder if I will even share these words. If you find yourself reading them, then you know I followed through.
The tough nights continued, troubled sleep bleeding into exhausted days. Never one to be overly fond of unnecessary suffering, I began using my EMDR app more mornings than not, in a quiet quest for relief from my self-torment. But, alas, PTSD has very strong claws. Into my soul, its talons cling tightly.
I have no death wish. It is my hope to endure well into my 90s. I also knew with every fiber of my being that this sense of despair would eventually pass.
“But it’s been over a decade,” whispered the PTSD into my ear. “I have you in my grips forever.”
Slowly the bad PTSD nights became less frequent. My mind started to heal and I felt my mental footing once again strengthen. Today, I am back to my normal brain-injured self, a marked improvement to where I was just last month. Go figure … I’ve come to a point in my recovery where being brain-injured isn’t the biggest problem in my life.
As I’ve done over the years, I share the solutions that have worked in my life. If they work for me, they might just work for you. There are ALWAYS solutions. Even in our most troubled moments, we must remember this.
First and most important, suicide is a permanent solution to a temporary problem—and it’s really not a solution at all. If you find yourself in a place where oblivion looks appealing, please speak with someone. You are worthwhile, and your life has value.
In my case, my wife, Sarah, is my trusted human. She is not my therapist, nor is she a doctor. She is someone I love and who loves me. We’ve been through so much together. We talk about anything—even tough topics like fragile mental health. When I tell her that I’ve had some dark thoughts, she knows exactly what I’m talking about. Sometimes she gives me a hug; other times she lets me know in no uncertain terms to suck it up, that we all are going through tough stuff right now.
The other lifesaver for me is to try to alter my perspective. While my mind might lie to me, saying things are going to be tough forever, the reality is that I have had many, many more good days than bad, and that every tough day—without exception—has passed. When times are difficult, just reminding myself that “this too shall pass,” can carry me through the next hour, or day.
It’s complicated. So much of my journey over the last decade has been two steps forward and one back. But the net/net over time always equals forward progress.
I really am okay—as okay as I can be. Again, if suicide looks like an option for you, I beg of you to speak with someone—kind of like I’m speaking with you here, today. You are not alone, though it may feel like it right now. Remember, it all passes—the good, the bad… and the dreadful.
And me? I am going to ride the wheels off this life, living my best life possible.
If you or someone you know is thinking about suicide—whether you are in crisis or not—please call or live chat the National Suicide Prevention Lifeline at 1-800-273-8255.
[ARTICLE] Do somatosensory deficits predict efficacy of neurorehabilitation using neuromuscular electrical stimulation for moderate to severe motor paralysis of the upper limb in chronic stroke? – Full Text
Various neurorehabilitation programs have been developed to promote recovery from motor impairment of upper extremities. However, the response of patients with chronic-phase stroke varies greatly. Prediction of the treatment response is important to provide appropriate and efficient rehabilitation. This study aimed to clarify whether clinical assessments, such as motor impairments and somatosensory deficits, before treatment could predict the treatment response in neurorehabilitation.
The data from patients who underwent neurorehabilitation using closed-loop electromyography (EMG)-controlled neuromuscular electrical stimulation were retrospectively analyzed. A total of 66 patients with chronic-phase stroke with moderate to severe paralysis were included. The changes from baseline in the Fugl-Meyer Assessment–Upper Extremity (FMA-UE) and the Motor Activity Log-14 (MAL-14) of amount of use (AOU) and quality of movement (QOM) were used to assess treatment response, and multivariate logistic regression analysis was performed using the extracted candidate predictors, such as baseline clinical assessments, to identify predictors of FMA-UE and MAL-14 improvement.
FMA-UE and MAL-14 scores improved significantly after the intervention (FMA-UE p < 0.01, AOU p < 0.01, QOM p < 0.01). On multivariate logistic regression analysis, tactile sensory (p = 0.043) and hand function (p = 0.030) were both identified as significant predictors of FMA-UE improvement, tactile sensory (p = 0.047) was a significant predictor of AOU improvement, and hand function (p = 0.026) was a significant predictor of QOM improvement. The regression equations explained 71.2% of the variance in the improvement of FMA-UE, 69.7% of AOU, and 69.7% of QOM.
Both motor and tactile sensory impairments predict improvement in motor function, tactile sensory impairment predicts improvement in the amount of paralytic hand use, and motor impairment predicts improvement in the quality of paralytic hand use following neurorehabilitation treatment in patients with moderate to severe paralysis in chronic-phase stroke. These findings may help select the appropriate treatment for patients with more severe paralysis and to maximize the treatment effect.
Motor impairment of the upper extremities is one of the major symptoms in patients with stroke. Motor impairment occurs in approximately 70% or more of patients,1,2 and various rehabilitation programs have been developed to promote recovery from motor impairment after stroke.3 In addition, with the recent development of neurorehabilitation, reports of interventions for residual motor paralysis in the chronic phase are increasing. However, the response to rehabilitation therapy of patients with chronic stroke varies greatly from patient to patient. Therefore, it is important to define an individualized rehabilitation treatment program according to the severity of stroke to provide appropriate and efficient rehabilitation. For this purpose, accurate prediction of the treatment response is necessary.
Somatosensory deficits, as well as motor impairments, are major symptoms in patients with stroke. Somatosensory deficits occur in more than 60% of patients4 and remain in about 40% of patients in the chronic phase.5 Along with motor impairments, somatosensory deficits affect motor functions and activities of daily living (ADLs), such as hand dexterity6,7 and grasping and manipulating objects.8–10 Although both motor and somatosensory functions are considered important predictors of motor function recovery in rehabilitation, many reports of patients with chronic stroke have focused only on motor function before intervention. In addition, reports using other clinical assessments, including of somatosensory deficits, are limited to mild to moderate paralysis.11 Thus, whether somatosensory impairment has an impact on the recovery of motor function in neurorehabilitation of patients with chronic stroke who have more severe paralysis remains unclear.
In addition to recovery of motor function, increasing the AOU and improving the quality of movement (QOM) of the paralyzed hand are also major goals of neurorehabilitation.12,13 It has been reported that baseline motor and somatosensory functions can both be used as predictors of the AOU and improvement in the QOM of the paralyzed hand by neurorehabilitation in subacute stroke patients.14 A report on chronic stroke patients also showed that both motor and somatosensory functions have a significant impact on prediction.15 However, similar to the recovery of motor function, reports on the AOU and QOM of the paralyzed hand are limited to mild to moderate paralysis.
This study aimed to determine the effects of clinical assessments of motor impairments and somatosensory deficits on the prediction of treatment response, such as recovery of motor impairments (increases in the amount of use and in the QOM of the paralyzed hand) in rehabilitation of patients with moderate to severe paralysis in chronic-phase stroke. We hypothesized that both pretreatment motor and somatosensory functions would be useful predictors of recovery of motor impairments (increased amount of use and improved QOM of the paralyzed hand).[…]