Archive for April, 2015

Routine and Habit – what helps you recover from TBI / PCS

Broken Brain - Brilliant Mind

When you’re recovering from mild TBI or post-concussion syndrome (PCS), having to reinvent the wheel for simple tasks is Enemy #1.

Having to re-think everything that you do, every hour of the day, is a killer. It sucks up critical mental cycles that could be used for other things, and it fills your brain with sludge from exertion. It turns you in to that Sisyphus, that mythical guy who pushed the rock up the hill each day, only to have it roll back down.

If you can create a daily/weekly routine to follow that gets you where you need to go on a regular basis, you can get on autopilot and make some real progress

That’s one of the things that’s been doing a number on me, lately – being off my routine. Starting new things and having to really rethink a lot of assumptions about how I can live…

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[ARTICLE] Effect of combined low-frequency repetitive transcranial magnetic stimulation and virtual reality training on upper limb function in subacute stroke: a double-blind randomized controlled trail

Summary

The effect of combined low-frequency repetitive transcranial magnetic stimulation (LF rTMS) and virtual reality (VR) training in patients after stroke was assessed. In a double-blind randomized controlled trial, 112 patients with hemiplegia after stroke were randomly divided into two groups: experimental and control. In experimental group, the patients received LF rTMS and VR training treatment, and those in control group received sham rTMS and VR training treatment. Participants in both groups received therapy of 6 days per week for 4 weeks. The primary endpoint including the upper limb motor function test of Fugl-meyer assessment (U-FMA) and wolf motor function test (WMFT), and the secondary endpoint including modified Barthel index (MBI) and 36-item Short Form Health Survey Questionnaire (SF-36) were assessed before and 4 weeks after treatment. Totally, 108 subjects completed the study (55 in experimental group and 53 in control group respectively). After 4-week treatment, the U-FMA scores [mean difference of 13.2, 95% confidence interval (CI) 3.6 to 22.7, P<0.01], WMFT scores (mean difference of 2.9, 95% CI 2.7 to 12.3, P<0.01), and MBI scores (mean difference 16.1, 95% CI 3.8 to 9.4, P<0.05) were significantly increased in the experimental group as compared with the control group. The results suggested the combined use of LF rTMS with VR training could effectively improve the upper limb function, the living activity, and the quality of life in patients with hemiplegia following subacute stroke, which may provide a better rehabilitation treatment for subacute stroke.

via Effect of combined low-frequency repetitive transcranial magnetic stimulation and virtual reality training on upper limb function in subacute stroke: a double-blind randomized controlled trail – Springer.

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[ARTICLE] New Generation Smartphone Models for Patient Rehabilitation Exercises – Full Text PDF

ABSTRACT

Patients with the frozen shoulder condition that limits their arm movement should seek rehabilitation assistance from a medical facility. The normal process is for the patients to travel from their home to a hospital or a medical center to see a physiotherapist. Such potentially cumbersome effort may reduce their motivation and determination to seek proper treatment. Our approach is to use a single smartphone with accelerometer, magnetic field, and gyroscope sensors to provide the necessary monitoring measurements to enable effective tele-rehabilitation. This work proposes a framework for such a system and has successful developed prototype based on the Android platform. Also, there are many different smartphones in the market. Therefore, we evaluated performance of three different smartphones, which are Samsung Google Nexus S, Samsung Galaxy Note 1, and Sony Xperia Z Ultra. According to the experimentation, we have shown that smartphones with the appropriate sensors are suitable for tele-rehabilitation. Also, a newer generation model would provide more precise measurements, as expected.

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[ARTICLE] Should Visual Restoration Therapy be Used in Patients With Visual Field Loss?

 

Should Visual Restoration Therapy be Used in Patients With V… : Journal of Neuro-Ophthalmology.

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[ARTICLE] A study on the natural history of scanning behaviour in patients with visual field defects after stroke – Full Text PDF

Abstract

Background

A visual field defect (VFD) is a common consequence of stroke with a detrimental effect upon the survivors’ functional ability and quality of life. The identification of effective treatments for VFD is a key priority relating to life post-stroke. Understanding the natural evolution of scanning compensation over time may have important ramifications for the development of efficacious therapies. The study aims to unravel the natural history of visual scanning behaviour in patients with VFD. The assessment of scanning patterns in the acute to chronic stages of stroke will reveal who does and does not learn to compensate for vision loss.

Methods/Design

Eye-tracking glasses are used to delineate eye movements in a cohort of 100 stroke patients immediately after stroke, and additionally at 6 and 12 months post-stroke. The longitudinal study will assess eye movements in static (sitting) and dynamic (walking) conditions. The primary outcome constitutes the change of lateral eye movements from the acute to chronic stages of stroke. Secondary outcomes include changes of lateral eye movements over time as a function of subgroup characteristics, such as side of VFD, stroke location, stroke severity and cognitive functioning.

Discussion

The longitudinal comparison of patients who do and do not learn compensatory scanning techniques may reveal important prognostic markers of natural recovery. Importantly, it may also help to determine the most effective treatment window for visual rehabilitation

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[ARTICLE] Recent development of mechanisms and control strategies for robot-assisted lower limb rehabilitation

Abstract

Robot-assisted rehabilitation and therapy has become more and more frequently used to help the elderly, disabled patients or movement disorders to perform exercise and training. The field of robot-assisted lower limb rehabilitation has rapidly evolved in the last decade. This article presents a review on the most recent progress (from year 2001 to 2014) of mechanisms, training modes and control strategies for lower limb rehabilitation robots. Special attention is paid to the adaptive robot control methods considering hybrid data fusion and patient evaluation in robot-assisted passive and active lower limb rehabilitation. The characteristics and clinical outcomes of different training modes and control algorithms in recent studies are analysed and summarized. Research gaps and future directions are also highlighted in this paper to improve the outcome of robot-assisted rehabilitation.

via Recent development of mechanisms and control strategies for robot-assisted lower limb rehabilitation.

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[ARTICLE] Effect of spatial target reaching training based on visual biofeedback on the upper extremity function of hemiplegic stroke patients – Full Text PDF

Abstract.

[Purpose] The aim of this study was to determine the effect of spatial target reaching training (TRT)
based on visual biofeedback (VB) on the upper extremity (UE) function of hemiplegic subjects.

[Subjects and Methods] Forty subjects between six and eighteen months post-stroke were enrolled in this study. They were randomly allocated to an experimental group (EG, n=20) and a control group (CG, n=20). All subjects received an hour of routine therapy for stroke three times a week for four weeks. Subjects in EG received additional spatial TRT based on VB using a 2-dimensional motion capture analysis system. Both groups were tested at pre and post-intervention. The motor function of each subject’s UE was assessed using the Fugl-Meyer (FM) test of UE and the Wolf Motor Function Test (WMFT). The reaching speed, angle and maximum reach distance were recorded using the motion capture analysis system. The experimental data were analyzed using the paired and independent t-tests.

[Results] The mean change scores of the FM Test of UE and WMFT show there was significantly more improvement at postintervention in EG than in CG. Also, the speed and angle reached showed significantly more increase in the EG
compared with the CG.

[Conclusions] The findings indicate that UE motor recovery of hemiplegic stroke patients
can be enhanced through the use of TRT based on VB.

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[WEB SITE] Low Serotonin, Depression Link a Myth?

The concept that depression is a result of low brain serotonin levels and, therefore, that selective serotonin reuptake inhibitors (SSRIs) are an effective treatment for the disorder is a myth, says a UK psychiatrist.

Moreover, David Healy, MD, professor of psychiatry, Hergest Unit, Bangor, Wales, United Kingdom, believes that SSRIs were a treatment looking for a condition and that doctors and patients were co-opted into the myth by clever marketing, resulting in better treatments being sidelined.

“This history raises a question about the weight doctors and others put on biological and epidemiological plausibility. Does a plausible (but mythical) account of biology and treatment let everyone put aside clinical trial data that show no evidence of lives saved or restored function?,” Dr Healy asks.

“In other areas of life the products we use, from computers to microwaves, improve year on year, but this is not the case for medicines, where this year’s treatments may achieve blockbuster sales despite being less effective and less safe than yesterday’s models,” he adds.

The editorial was published online April 21 in the BMJ.

Doctors, Patients Co-opted

Outlining the history of SSRIs, Dr Healy says that in the 1960s, the notion that serotonin levels are lower in persons with depression was rejected, and SSRIs were shown to be less effective than tricyclic antidepressants. The SSRIs were then marketed as tranquilizers, for which they were equally unsuccessful.

Continue —> Low Serotonin, Depression Link a Myth?.

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[WEB SITE] Studies reveal how high-fat low-carb diets affect brain activity and highlight an approach for treating epilepsy with metabolic drugs.

One percent of the world’s population suffer from epilepsy, and a third of sufferers cannot be treated with antiepileptic drugs. Diet control has been used to treat patients suffering from drug-resistant epilepsy since the 1920s, but how metabolic processes affect epilepsy has not been fully understood. Now researchers at Okayama University and Kawasaki Medical School have identified the metabolic pathways altered by diet treatments, the enzymes that can control them and potential metabolic drugs that may be effective for treating types of epilepsy that are resistant to other drugs.

‘Ketogenic’ diets used to treat epilepsy are high in fat and low in carbohydrate. Due to the scarcity of glucose available as a result, the brain metabolises ketones, which uses a different metabolic pathway.

Tsuyoshi Inoue and his team examined neural cells in an artificial cerebrospinal fluid solution  switched from glucose to ketones. When glucose was switched to ketones the cells became hyperpolarized – a change in the cell’s membrane potential that makes neurons less prone to becoming excited and active.

The researchers further broke down the processes in the metabolism of glucose and identified a crucial enzyme – lactate dehydrogenase (LDH). Blocking LDH mimicked the switch from glucose to ketones in vitro. Further in vivo tests on mice confirmed the effect.

By testing the drugs already in use they identified LDH inhibitory action in stiripentol, a drug used for a rare form of the epilepsy. By modifying its chemical structure, they found an alternative LDH inhibitor with a similar structure that was more effective for in vivo tests on mice. They conclude, “Our study opens a realistic path to develop compounds for drug-resistant epilepsy by targeting LDH enzymes with stiripentol derivatives.”

Background

Epilepsy

Epilepsy describes the neurological disorder that results in seizures that have no other known cause. The seizures result from excessive excitation in the cortical nerve in the brain and the length and severity of the seizures may vary.

The transmission of signals by neurons relies on the rapid rise and fall of the membrane potential, and is affected by cell polarization. When the cell membrane becomes hyperpolarized, a greater stimulus is required to produce an action potential. As a result hyperpolarization can prevent the excessive cortical activity that causes epileptic seizures.

Continue —> Health News – Studies reveal how high-fat low-carb diets affect brain activity and highlight an approach for treating epilepsy with metabolic drugs..

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[ARTICLE] Informal Care Provision by the Family to Hospitalized Patients in a Rehabilitation Clinic of Western Greece – Full Text PDF

Abstract

Introduction: Recognizing the burden imposed on families and society by long-term care of chronically ill patients, there is a need to empower caregivers and take measures for slowing the deterioration of the quality of life for the caregiver and the patient.

Aim: The main aim of the present study was to investigate the caregivers’ views regarding the services provided by them for their hospitalized relatives and their opinions about the their health education needs, informational needs and needs for support in a rehabilitation clinic of Western Greece.

Methodology: The sample consisted of 75 caregivers of hospitalized patients who provided unpaid services and they wanted after informed consent to participate in the study. Data were collected in 2012 within a period of 6 months. A self-reported questionnaire was completed and the statistical analysis was performed by the use of SPSS.

Results: This study shows the need for caregivers’ health education on technical care and general knowledge about the disease, on how to handle an emergency situation at home. Obvious were also the need for information about the benefits to disabled people from public and non- profit organizations, but also the need for learning how to support emotionally patient. Information about the transition from hospital to home, emerged as necessary through this study. Caregivers felt that it is the obligation of the hospital to provide training and health education and indicated nurses as appropriate health professionals for the role. Also the need for emotional support for caregivers by health professionals was highlited and caregivers believe that adequate staffing of rehabilitation units will allow health professionals to provide time for emotional support of caregivers, but also time for casual conversation on general subjects, in a civilized environment, aiming to empower caregivers for better care of patients.

Conclusion: The health education needs of the caregiver must be sufficient, after careful assessment of training needs, information and emotional support and by strengthening the concept of self-care of the caregiver. To address these needs, specific training plan is required, preparing the caregiver in his new role and adjustment to the new lifestyle.

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