Archive for November, 2014
[ARTICLE] Neuromotor Rehabilitation and Cognitive Outcomes in Patients with Traumatic Brain Injury through the Method BAPNE
After the acute phase of hospitalization, patients with severe brain injury, requiring interventions in health and social care in the long term: the work of rehabilitators is to facilitate the recovery of several disorders caused by trauma and involves all possible areas to return the patient to full functionality within the autonomy and satisfaction of basic needs, and psychological support they need.
The recent use of body percussion through BAPNE method in neurorehabilitation offers the possibility of studying the development of motor skills, attention, coordination, memory and social interaction of patients with neurological diseases.
The experimental protocol involves 52 patients with GCA selected on the basis of shared and structured requirements.The trial will provide the coaching protocol BAPNE (in two weekly sessions of 50 minutes to a maximum of 10 weeks in a group of patients), to the traditional rehabilitation activities. The control group will continue to perform exclusively the cognitive and neuromotor rehabilitation according to traditional protocols.
All subjects will be: monitored the levels of cortisol in-time 0 – 75-180 days; recorded beats per minute through a heart rate monitor on your wrist; through the use of Lybra (equilibrium) and Kimeja (virtual reality) will be recorded data regarding the ability to adjust the balance of the patient in standing and sitting using the visual input and data relating to the patient’s ability to coordinate fine motor skills in a virtual environment; through the administration of neuropsychological tests (HADS, NPI) will be detected improvements in mood and behavioral disturbances in the regression if available.
At 6 months after administration of the protocol is expected to re-test to assess if present, the maintenance of the effects of rehabilitation obtained. The research is led by three neurologists from the center of neurorehabilitation Fondazione Roboris ASL RME in Rome.
[ARTICLE] AN INNOVATIVE SOLUTION BASED ON HUMAN – COMPUTER INTERACTION TO SUPPORT COGNITIVE REHABILITATION – Full Text PDF
One third of the stroke sufferers experience long-term physical and/or cognitive disabilities, and stroke is considered to be the most common cause for severe disability and even death. Following a stroke incident, a significant proportion of patients can suffer from Apraxia and/or Action Disorganisation Syndrome (AADS) which, among other symptoms, is demonstrated by the impairment of cognitive abilities to carry out Activities of Daily Living (ADL) (Hermsdörfer, 2003; Goldenberg, 1998; Liepmann, 1908).
Most common rehabilitation systems are focused on treating physiological aspects of stroke, such as limb movement (Freeman, 2012), and are based on robot or virtual environment platforms which are expensive and not effective for a home base environment (Amirabdollahian, 2001; Kahn, 2001; Krebs, 2003; Shor, 2001). Furthermore, they are space dependent, requiring the patient to function within their working space rather than adapting to patient’s natural environment.
To date, most common rehabilitation systems that are based on Information and Communication Technologies (ICT) focus on treating physiological symptoms of stroke (e.g. muscle weakness) (Galiana, 2012; Kesner, 2011; Mao, 2010; Ueda, 2010). These systems are inappropriate for rehabilitation of the cognitive basis of AADS. Moreover, these systems tend to be expensive and so impractical for home installations. As a consequence, this affects the continuity of therapy and weakens its impact.
This paper presents a different solution whose contribution is part of a European project called CogWatch (http://www.cogwatch.eu/). The aim is to provide a rehabilitation system based on highly instrumented common objects and tools, wearable and ambient devices that are part of patients’ everyday environment and can be used to monitor behavior and progress as well as re-train them to carry out ADL through persistent multimodal feedback at home.
The document is divided into several sections. Section II presents a brief description of AADS patients and the effects of stroke. Once the main features of these patients are described, the physical description of the platform and how the system works are presented in section III and section IV in order to detail an experiment carried out to assess the solution adopted in section V. Finally, in section VI, a conclusion and brief summary of the general results are presented…
For people living with paralysis, restoration of hand function remains the top priority because it leads to independence and improvement in quality of life. In approaches to restore hand and arm function, a goal is to better engage voluntary control and counteract maladaptive brain reorganization that results from non-use.
Standard rehabilitation augmented with developments from the study of brain-computer interfaces could provide a combined therapy approach for motor cortex rehabilitation and to alleviate motor impairments.
In this paper, an adaptive brain-computer interface system intended for application to control a functional electrical stimulation device is developed as an experimental test bed for augmenting rehabilitation with a brain-computer interface.
The system’s performance is improved throughout rehabilitation by passive user feedback and reinforcement learning. By continuously adapting to the user’s brain activity, similar adaptive systems could be used to support clinical brain-computer interface neurorehabilitation over multiple days…
…Goebel and his team have developed an advanced software system for the real-time analysis of functional MRI brain scans. He scans the brain and analyzes brain activity in the regions of the brain related to the problem of the patient. The patient is shown this neuro-feedback real-time through a brain-computer interface. Through this feedback, a severely depressed person can visualize how his brain activity influences the way he feels and the way he can control these emotions by personally activating or de-activating activity in relevant parts of his brain, with astonishing results. Goebel also shows us the different neurological responses of different people, from one of the happiest men in the world to a girl with locked-in syndrome…
…It’s generally believed that there is little that can be done to reverse the signs of brain injury, but the research groups headed by Dr. Cummings and Dr. Anderson are investigating how these lost cells may be partially replaced by transplanting multipotent human neural stem cells (hNSCs), a specialized subset of stem cells which can form cells of the nervous system. If the cells that are lost when neurotrauma occurs can be replaced by hNSCs, it may be possible to restore function after injury…
Abstract: The aim of this study is investigate the effect of arm swing exercise on balance and gait in stroke patients.
Group A (n=8): 0.5kg strap was applied during arm swing exercise in experimental group for 30 minutes a day, 3 times a week for 4 weeks. Group B (n=8): Subjects in control group performed neurodevelopmental treatment for 30 minutes a day, 3 times a week for 4 weeks. Subjects were measured for balance and gait on Berg Balance scale, 10meter walking test and Six-minute walk test.
There were significant changed of 10Meter Walking Test and 6-Minute Walk Test after experimental group performed the reinforced arm swing exercise of upper extremities and control group was provided with neurodevelopment treatment(p <0.05).
However, there was no statistically significant found difference change of Berg Balance Scale in experimental group (p >0.05). The application reinforced arm swing exercise can be said to be effective intervention for the gait training in hemiplegic stroke patient.
Abstract: Successful rehabilitation of stroke patients is strongly dependent on the engagement of patients. During a whole rehabilitation program, mundane rehabilitation exercises can easily become routine for patients, leading to boredom and as a result to ineffective functional recovery. This has been taken into consideration just by few rehabilitation systems. Engagement in rehabilitation can be decomposed into long term engagement (LTE) and short term engagement (STE) for the reason that their indicators and stimulation strategies are different.
This paper proposes various engaging strategies to optimize both LTE and STE of patients. Actually, proposes to combine the strategies concerning the whole rehabilitation program and the strategies to be applied during single rehabilitation exercises. Based on the proposed reasoning model, a cyber-physical computing based solution for a personalized rehabilitation system is proposed. Various cyberphysical characteristics, such as function augmentation, adaptive and learning control, are being implemented in the system in order to realize the various strategies of engagement
Cognitive rehabilitation is a group of designed techniques that is for the promotion of cognitive domains in people with disease or disability. Cognitive rehabilitation therapy (CRT) is the science of restoring cognitive processing and learning compensatory strategies and it affects the molecular and cellular recovery rehabilitation by integration of behavioral and cognitive changes.
The promotion of rehabilitation science of cognitive neuroscience has made it a priority by the help of full range of effected interventional procedures. And it has been able to achieve the desired goals in the chain of theoretical and experimental science on the basis of behavioral interventions which is made of neuroscience, cognitive neuroscience, psychology, physiology, pharmacology, medical imaging, and other medical disciplines and achieved some success in compensatory and medical strategies after surgery.
Cognitive impairment after brain surgery is huge health challenges beyond the common disorders associated with diseases. Our approach to CRT is on the assumption that treatment would be the most effective way when focusing on the cognitive sub-systems after neurosurgery and these are also affected by other aspects of life as a patient emotions, nutrition, health, stress, and social performance. Intervention in the passive skills can lead to neuro-cognitive rehabilitation that includes designed experience on the basis of nerve and brain function and structure. A failure of cognitive or brain processing during or after surgery is an abnormal result and these impairments are treated better with CRT.
This method on the basis of neuroplastisity, reorganization of damaged cortical through morphological and physiological responses of nerve reconstruction ways by techniques in neuro-cognitive disorders due to illness, injury or disability, even in healthy individuals which are affected by environment, the complexity of stimulation, repeated tasks and motivation.
The objective was to examine the effectiveness of a 3-week balance training program using the Nintendo Wii Fit gaming system (Nintendo Wii Sports, Nintendo, Redmond, WA) on lower limb corticomotor excitability and other clinical measures in chronic stroke survivors.
Ten individuals diagnosed with ischemic stroke with residual hemiparesis received balance training using the Wii Fit for 60 min/day, three times/week, for three weeks. At the end of training, an increase in interhemispheric symmetry of corticomotor excitability of the tibialis anterior muscle representations was noted (n = 9).
Participants also showed improvements in reaction time, time to perform the Dual Timed-Up-and-Go test, and balance confidence. The training-induced balance in corticomotor excitability suggests that this Wii-based balance training paradigm has the potential to influence neural plasticity and thereby functional recovery.
Background: Nowadays there is still lack of effective method to evaluate post-stroke depression. To distinguish patients with and without depression after stroke reliably, this study proposes a new Post Stroke Depression Scale (PSDS).
Methods: PSDS was developed based on various depression scales and clinician experiences. 158 stroke patients who were able to finish PSDS and Hamilton Depression Rating Scale (HDRS) were recruited. Cronbach α, Spearman rank coefficient and Kruskal-Wallis test were respectively used to examine reliability, internal consistency and discriminate validity. Then the Receiver Operating Characteristic (ROC) curve was used to determine the ability of scale and categorized scales to the range of depression. Finally, the factors of the PSDS were classified by average clustering analysis.
Results: The Cronbach α of PSDS was 0.797 (95% CI) indicted a good reliability. The Spearman correlation coefficient between PSDS and HDRS was 0.822 (P<0.001) showed an excellent congruent validity. The discriminate validity displayed significant difference between patients with and without depression (P<0.001). 6/24 was set to be the cut-off value by ROC analysis. Moreover, the different severity was distinguished by the value 6/24, 15/24 and 17/24.
Limitations: The small sample size maybe the main limitation, the larger sample used in different field according sex, age and side-lesion were needed to verity the results. The cut off value calculated by ROC curve maybe react the severity of the disease to some extent, but it is not absolute.
Conclusions: PSDS is a valid, reliable and specific tool for evaluating post-stroke depression patients and can be conveniently utilized.