Archive for January, 2016

[ARTICLE] Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes – Full Text HTML

Abstract 

This study examined functional outcomes, health-related quality of life (HRQoL), and satisfaction in a group of Veterans who received physical therapy via an in-home video telerehabilitation program, the Rural Veterans TeleRehabilitation Initiative (RVTRI). A retrospective, pre–post study design was used. Measures obtained from 26 Veterans who received physical therapy in the RVTRI program between February 22, 2010, and April 1, 2011, were analyzed. Outcomes were the Functional Independence Measure (FIM); Quick Disabilities of the Arm, Shoulder, and Hand measure; Montreal Cognitive Assessment (MoCA); and the 2-minute walk test (2MWT). HRQoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12), and program satisfaction was evaluated using a telehealth satisfaction scale. Average length of participation was 99.2 +/– 43.3 d and Veterans, on average, received 15.2 +/– 6.0 therapeutic sessions. Significant improvement was shown in the participants’ FIM (p < 0.001, r = 0.63), MoCA (p = 0.01, r= 0.44), 2MWT (p = 0.006, r = 0.73), and VR-12 (p = 0.02, r = 0.42). All Veterans reported satisfaction with their telerehabilitation experiences. Those enrolled in the RVTRI program avoided an average of 2,774.7 +/– 3,197.4 travel miles, 46.3 +/– 53.3 hr of driving time, and $1,151.50 +/– $1,326.90 in travel reimbursement. RVTRI provided an effective real-time, home-based, physical therapy.

INTRODUCTION

The mission of the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) is to deliver uniform high-quality care to all Veterans, regardless of geography, distance, or economic circumstances. To meet this mission, the VHA must reach Veterans regardless of barriers to care provision, including long travel times and distances and expense. These barriers are magnified for rural Veterans with disabilities who require rehabilitation services. These individuals must invest additional time, thought, and resources in order to reach distant medical centers. Many rehabilitation protocols involve repeated therapy sessions, often two to five times weekly over weeks or months, resulting in additional physical, financial, and logistical hardships. In order to fulfill its promise, the VHA is actively attempting to address the gap in services for Veterans with limited access to traditional modes of treatment.

The VHA presently serves 3.3 million Veterans residing in rural localities. These individuals represent 41 percent of all Veterans enrolled in the VHA. Nearly 43 percent (2.27 million) of Veterans served by the VHA with a service-­connected disability live in rural or highly rural areas [1]. Therefore, the VHA is looking to new technologies to facilitate access to healthcare for these individuals. As stated by W. Scott Gould, the former U.S. Deputy Secretary of Veterans Affairs, “We are investing more in telehealth technologies to make VA healthcare available to Veterans wherever they live. In FY [fiscal year] 2010, we invested $121 million in telehealth. In FY2011, those investments will grow to $163 million. By the end of FY2012, we expect to have doubled our present use of telehealth” [2]. Robert A. Petzel, the former Under Secretary for Health of the VA, has explicitly endorsed home telehealth technologies. In testimony before the House Committee on Veterans’ Health on February 23, 2010, he stated, “Our increasing reliance on noninstitutional long-term care includes an investment in 2011 of $163 million in home telehealth. Taking greater advantage of the latest technological advancements in healthcare delivery will allow us to more closely monitor the health status of Veterans and will greatly improve access to care. Telehealth will place specialized healthcare professionals in direct contact with patients using modern IT [information technology] tools” [3].

Telerehabilitation refers to the clinical application of consultative, preventative, diagnostic, and therapeutic services via two-way interactive telecommunication technologies [4–5]. Telerehabilitation is an alternative to usual-care outpatient rehabilitation services. It can also serve as an alternative to “homecare” rehabilitation, which requires the treating therapist or clinician to travel to the patient’s home. By reducing or eliminating barriers relating to travel time and travel-related costs, telerehabilitation has the potential to improve access to rehabilitative care for stroke survivors [6–7]. Improving access to rehabilitative care may reduce disparities for stroke survivors and caregivers facing financial or transportation-related challenges. While research on telerehabilitation is limited, there is increasing evidence supporting the need for telerehabilitation services, the development of telerehabilitation interventions, and support for people with disabling conditions that potentially limit access to rehabilitation services [6–14].

The emerging field of video-based telerehabilitation allows therapists to deliver rehabilitative care to Veterans with physical, financial, and logistical barriers to healthcare providers and facilities [5]. Telerehabilitation has expanded dramatically in recent years as a result of advances in technology, increases in speed of telecommunication, and decreases in costs of computer hardware and software [6]. The scope of telerehabilitation includes direct therapeutic interventions, disease monitoring, coordination of care, patient and caregiver training and education, patient networking, and multidisciplinary professional consultation [15–16].

Veteran access to healthcare services is a topic of high interest and concern to both providers and researchers [6,17–20]. Numerous factors may interfere with patient access to healthcare, including distance, high travel-related expenses, reduced numbers of healthcare providers within rural areas, transportation barriers, caregiver burden, attitude toward and perception of medical care providers, consumer knowledge, informal caregiver and/or familial supports, and ethnic and cultural differences. Reduced access to healthcare contributes to increased morbidity and mortality, increased cost of treatment, and inappropriate use of emergency services [21–24]. Available technologies allow for rehabilitative services to be provided in real-time from providers’ clinics to various recipients’ locations such as home, community, health facilities, and/or work settings. While popular enthusiasm and capital investment in telerehabilitation continue to grow, very little is known regarding the efficacy of telerehabilitation or patients’ overall evaluation and acceptance of telerehabilitation services [25]. A recent Cochran review concerning telerehabilitation services provided to patients during recovery from stroke concluded that sufficient data do not exist to support the effectiveness of telerehabilitation as a stand-alone replacement for traditional rehabilitative services for the restoration of activities of daily living, mobility, upper-limb function, health-related quality of life (HRQoL), patient satisfaction, or cost savings for patients receiving rehabilitative care following stroke [5]. The purpose of this study was to assess the functional outcomes, HRQoL, and satisfaction of a group of patients who participated in a VA telerehabilitation program.

 

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[ARTICLE] Driving with Homonymous Visual Field Defects: Driving Performance and Compensatory Gaze Movements – Full Text PDF

Aim of this pilot study was to assess the driving performance and its relationship to the visual search behavior, i.e., eye and head movements, of patients with homonymous visual field defects (HVFDs) in comparison to healthy-sighted subjects during a simulated driving test.

Eight HVFD patients and six healthy-sighted ageand gender-matched control subjects underwent a 40-minute driving test with nine hazardous situations. Eye and head movements were recorded during the drive.

Four out of eight patients passed the driving test and showed a driving performance similar to that of the control group. One control group subject failed the test. Patients who passed the test showed an increased number of head and eye movements. Patients who failed the test showed a rightwards-bias in average lane position, probably in an attempt to maximize the safety margin to oncoming traffic.

Our study supports the hypothesis that a considerable subgroup of subjects with HVFDs show a safe driving behavior, because they adapt their viewing behavior by increased visual scanning.

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[WEB SITE] Spasticity and Traumatic Brain Injury – MSKTC

Spasticity and Traumatic Brain Injury

Based on Research by TBI Model Systems

man's body

What is spasticity?

It is common in persons with severe brain injuries (TBI). People with spasticity may feel as if their muscles have contracted and will not relax or stretch. They may also feel muscle weakness, loss of fine motor control (for example, being unable to pick up small objects), and overactive reflexes.

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What you need to know

  • Many people with TBI either do not have spasticity or have easily controlled spasticity
  • Your brain injury may cause the muscles in your body to become stiff, overactive, and difficult to stretch. The muscle may “spasm” or tighten suddenly. Doctors call this effect spasticity (pronounced spas-TIS-it-ee).
  • Spasticity may not be bothersome and does not always need treatment.
  • Spasticity may come and go. It may be worse during certain activities or it may become worse at night. It can interfere with sleep or limit the ability to function. When problems such as these arise, there is more need to consider treating it.
  • There are ways to treat spasticity or relax muscles, ranging from controlling triggers to taking medicines.
  • When only a few muscles are affected, focal treatments such as nerve blocks and botulinum toxin injections (described below) may be considered. There may also be surgery options.

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Understanding Your Body: How Muscles Work

Your brain communicates though your spinal cord and nerves to your muscles and causes them to contract and relax. After brain injury, the messages between brain and muscles may become unregulated leading to unwanted muscle contractions.

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What are the symptoms of spasticity?

The symptoms and degree of spasticity are different in each person and can include:

  • Sudden, involuntary tightening or relaxing of a limb, or jerking of muscles in the trunk (chest, back, and abdomen).
  • Muscle tightness during activity, making it difficult to control movement.

When am I most likely to experience symptoms?

Spasticity can happen at any time, but is most likely to occur when you:

  • Stretch or move an arm or a leg.
  • Have a urinary tract infection or a full bladder.
  • Have constipation or large hemorrhoids.
  • Have an injury to the muscles, tendons, or bones (including bone fractures).
  • Wear tight clothing or wraps.
  • Feel emotional stress.
  • Have any kind of skin irritation*

(Skin irritation includes rubbing, chafing, a rash, in-grown toenails, or a skin sensation that is too hot, too cold, or causes pain. This also includes pressure sores or ulcers caused by staying in one position for too long.

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Does spasticity need to be treated?

Spasticity is not always harmful or bothersome and does not always need to be treated. Sometimes, however, there are problems caused by spasticity that can be bothersome or harmful.

Problems caused by spasticity include:

  • Pain when muscles tighten.
  • Limited motion, especially in joints that can limit walking or moving in and out of beds or chairs.
  • Difficulty taking deep breaths.
  • Falls
  • Poor positioning in a chair, wheelchair, or bed.
  • Poor sleep and tiredness during the day.
  • Skin pressure ulcers.
  • Difficulty maintaining proper hygiene.
  • Limits on normal activities such as feeding or grooming.
  • Limited use of your hands.

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What can I do to manage my muscle spasticity?

Urinary tract infections and skin breakdown can be avoided by keeping skin clean, wearing loose clothing, and changing positions regularly. Taking extra care when moving from a chair or bed can also help keep triggers from occurring. Other triggers such as constipation or large hemorrhoids can be avoided by eating a high fiber diet and drinking plenty of water. Even though stretching can sometimes be a trigger of spasticity, daily stretching can actually help you maintain flexibility. Sometimes, wearing splints can keep spasticity from becoming worse.

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Coping with Spasticity through Physical Treatments

The following treatments will help to maintain flexibility and therefore reduce spasticity and the risk for permanent joint contracture:

  • Regular stretching (range-of-motion) exercises will help maintain flexibility and temporarily reduce muscle tightness in mild to moderate spasticity.
  • Splints, braces, or progressive casting into the desired position provides continuous muscle stretching that helps to maintain flexibility; ideally it is a position that does not trigger your spasticity.
  • Careful use of cold packs or stretching and exercise in a pool may help.

It is important to get the advice of a physician or therapist on what physical treatments are correct and safe.

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Oral Medicine

Medication may help control spasticity but may have side effects, and is probably most useful when you have spasticity in several parts of your body. Common side effects, such as sleepiness, might be more intense after a brain injury. You should discuss the benefits and side effects of various medications with a physician. Appropriate medications may include:

  • Baclofen (Lioresal®)
  • Dantrolene (Dantrium®)
  • Tizanidine (Zanaflex®)
  • Benzodiazepines such as diazepam (Valium®) or clonazepam (Klonopin®)

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Focal Interventions

Sometimes a person may have side effects to oral medication or may only have spasticity in a single location. For those types of spasticity, anesthetic medications, alcohol, phenol (pronounced FEE-noll), or neurotoxins (such as botulinum toxin, Botox®, Dysport®, Xeomin®, Myobloc®) can be injected into the muscles and nerves (usually in the arms and legs) to reduce unwanted muscle hyperactivity to control spasticity in local areas. These injections rarely cause widespread side effects and do not affect the brain or spinal cord. The benefits of the injections are temporary, so they must be repeated several times a year. These injections require regular stretching to be most effective. Injections can be used safely in combination with other spasticity management.

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Intrathecal Baclofen (ITB) Pump

Intrathecal baclofen pumps are small hockey-puck sized devices that release tiny amounts of baclofen into the space around the spinal column. Baclofen is the most commonly used medication for spasticity. Intrathecal baclofen (pronounced in-TRAH-theh-cal BAK-loh-fen) pumps can be especially helpful after a traumatic brain injury. A surgery is performed to implant a small battery-powered computer and pump, usually in the patient’s abdomen. Intrathecal baclofen can be used along with other spasticity treatments. Like other treatments, this pump can reduce the frequency and intensity of spasms. It has the advantage of maximizing the beneficial effects of baclofen with fewer side effects than taking baclofen by mouth.

Although rare, there are serious risks associated with intrathecal baclofen and it is important to discuss the risks with your physician and comply with careful monitoring.

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Authorship

Spasticity after Traumatic Brain Injury was developed by Kathleen Bell, M.D. and Craig DiTommaso, M.D., in collaboration with the Model Systems Knowledge Translation Center

Source

Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model Systems.

Disclaimer

This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. The contents of this factsheet were developed under a grant from the U.S. Department of Education, NIDRR grant number H133A110004. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.

Copyright 2015

Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.

Source: Spasticity

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[WEB SITE] Technique Could Reconnect Neurons in People with Central Nervous System Damage – Neuroscience News

That very fine hair-line object that you see being pulled across the screen is actually a neuron being made. A research team led by McGill University and the Montreal Neurological Institute has managed to create new functional connections between neurons for the first time. Apart from the fact that these artificial neurons grow over 60 times faster than neurons naturally do, they are indistinguishable from ones that grow naturally in our bodies.

“It’s really very exciting, because the central nervous system doesn’t regenerate,” says Montserrat Lopez, a McGill post-doctoral fellow who spent four years developing, fine-tuning and testing the new technique. “What we’ve discovered should make it possible to develop new types of surgery and therapies for those with central nervous system damage or diseases.”

Rewiring a neuron takes some very careful moves

Because neurons are about the size of 1/100th of a single strand of hair, it takes some very specialized instruments and a lot of careful manipulation to create healthy neuronal connections that transmit electrical signals in the same way that naturally-grown neurons do.

The researchers used an atomic force microscope to attach a very small polystyrene ball (a few micrometers in size) to a portion of a neuron that acts as the transmitter, which they then stretched, a bit like pulling on a rubber band, to extend and connect with the part of the neuron that acts as a receiver.

“We would never have made this discovery if the people working in the lab hadn’t figured out that you had to avoid any quick or jerky movements when you move the newly-made neurons around,” says Peter Grutter, a McGill physics professor and the senior author on the paper that was published last week in the Journal of Neuroscience. “Until they found the right way to walk the neurons across the lab, from the microscope to the incubator where the newly-made neurons are left to grow for 24 hours, we weren’t having any luck getting them to behave the way we wanted them to.”

Mechanically pulled connection between two neurons. Left: before, right: after manipulation. Credit: The researchers.

Sometimes letting go can be hard to do

An even bigger challenge than getting the neurons to connect in the proper way, proved to be getting the newly-formed neurons to detach from the tool that had been used to create them without being destroyed in the process. Eventually, the researchers figured out how to sever the connection and still preserve the functional neuron by releasing the beads.

Although it is now possible to create new neuronal connections, there is still much work ahead.


McGill researchers have been able to artificially create functional neurons that grow over 60 times faster that neurons do naturally. What you are seeing is the creation of a functional neuronal circuit, as part of a neuron attached to a small bead is gently stretched to connect with part of another neuron.

“The neurons we were able to create were just under 1mm long, but that’s because we were limited by the size of the dish we used,” says Margaret Magdesian, a neuroscientist who is the first author on the paper, and who worked at the Montreal Neurological Institute when the research was done. ”This technique can potentially create neurons that are several mms long, but clearly more studies will need to be done to understand whether and how these micro-manipulated connections differ from natural ones.”

ABOUT THIS STRESS AND NEUROSCIENCE RESEARCH

Funding: Financial support for the research was provided by the Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant, McGill University, James McGill research stipend, Le regroupement québécois sur les
matériaux de pointe—Fond de recherche du Québec—Nature et technologies, Canadian Institutes of Health ResearchTraining Grant, and NSERC Collaborative Research and Training Experience.

Source: McGill University
Image Source: The image is credited to the researchers
Video Source: The video is available at the McGill YouTube page
Original Research: Abstract for “Rapid Mechanically Controlled Rewiring of Neuronal Circuits” by Margaret H. Magdesian, G. Monserratt Lopez-Ayon, Megumi Mori, Dominic Boudreau, Alexis Goulet-Hanssens, Ricardo Sanz, Yoichi Miyahara, Christopher J. Barrett, Alyson E. Fournier, Yves De Koninck, and Peter Grütter inJournal of Neuroscience. Published online January 20 2016doi:10.1523/JNEUROSCI.1667-15.2016


Abstract

Rapid Mechanically Controlled Rewiring of Neuronal Circuits

CNS injury may lead to permanent functional deficits because it is still not possible to regenerate axons over long distances and accurately reconnect them with an appropriate target. Using rat neurons, microtools, and nanotools, we show that new, functional neurites can be created and precisely positioned to directly (re)wire neuronal networks. We show that an adhesive contact made onto an axon or dendrite can be pulled to initiate a new neurite that can be mechanically guided to form new synapses at up to 0.8 mm distance in <1 h. Our findings challenge current understanding of the limits of neuronal growth and have direct implications for the development of new therapies and surgical techniques to achieve functional regeneration.

SIGNIFICANCE STATEMENT Brain and spinal cord injury may lead to permanent disability and death because it is still not possible to regenerate neurons over long distances and accurately reconnect them with an appropriate target. Using microtools and nanotools we have developed a new method to rapidly initiate, elongate, and precisely connect new functional neuronal circuits over long distances. The extension rates achieved are ≥60 times faster than previously reported. Our findings have direct implications for the development of new therapies and surgical techniques to achieve functional regeneration after trauma and in neurodegenerative diseases. It also opens the door for the direct wiring of robust brain–machine interfaces as well as for investigations of fundamental aspects of neuronal signal processing and neuronal function.

“Rapid Mechanically Controlled Rewiring of Neuronal Circuits” by Margaret H. Magdesian, G. Monserratt Lopez-Ayon, Megumi Mori, Dominic Boudreau, Alexis Goulet-Hanssens, Ricardo Sanz, Yoichi Miyahara, Christopher J. Barrett, Alyson E. Fournier, Yves De Koninck, and Peter Grütter in Journal of Neuroscience. Published online January 20 2016 doi:10.1523/JNEUROSCI.1667-15.2016

Source: Technique Could Reconnect Neurons in People with Central Nervous System Damage – Neuroscience News

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[Abstract] A novel motion-coupling design for a jointless tendon-driven finger exoskeleton for rehabilitation

Abstract

We have designed a new jointless tendon-driven exoskeleton plan for the human hand that provides a correct and stable motion sequence while keeping the structure lightweight, compact and portable. Before the development, anatomy analysis and a kinematics study of the human finger were performed, and bending angle relationships among the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints were analyzed. Detailed implementation is discussed, including the basic theory of the joint motion coupling method, related formula derivations and mechanical design of an experimental device. An experimental setup was built, and series of experiments was conducted to examine and evaluate the developed joint motion coupling plan.The results indicated that the new plan worked correctly as desired, that an incorrect finger motion sequence did not occur and that the new coupled tendon driven plan can drive finger bending as naturally as a human. The compactness and light weight of the entire structure of the device means that its parts can be arranged for a hand glove or fingerstall more easily than most bar-linkage exoskeleton structures.

 

Source: A novel motion-coupling design for a jointless tendon-driven finger exoskeleton for rehabilitation

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[ARTICLE] Rhythmic Haptic Cueing for Entrainment: Assisting post-stroke gait rehabilitation – Full Text PDF

Abstract:

Restoring mobility and rehabilitation of gait are high priorities for rehabilitation of neurological conditions. Cueing using metronomic rhythmic sensory stimulation via entrainment has been shown to improve gait, but almost all previous versions of this approach have used auditory or visual cues. In contrast, we have developed and pilot-tested a prototype wearable system for rhythmic cueing based on haptics. Our initial pilot study indicated the same kinds of improvement to gait with haptics as for other cueing modalities, but haptics offer some advantages over audio and visual cues. In particular, haptics are generally more practical for use out of doors, in noisy environments, or when wishing to keep open the ability to converse freely. However, haptics also allow the precisely targeted spatial placement of cues on alternate limbs, offering the ability to manipulate attention and proprioception for therapeutic benefit. We outline the theory behind our approach and report on the iterative design of the system as part of a user-centred design evaluation process involving a wide range of stakeholders.

1 Introduction

Stroke is a sudden and devastating disease with major implications to a person’s health and quality of life. In contrast to other sudden diseases, such as heart disease, stroke has a long-term disability burden. The disability impact of stroke is greater than any other chronic disease, causing a wider range of complex disabilities (including locomotion, dexterity, and communication related disabilities), making stroke a leading cause of adult disability (Adamson et al. 2004). More than half of all stroke survivors are left dependent on others for everyday activities (Intercollegiate Stroke Working Party 2012). After acute specialist hospital care, a person’s recovery can significantly improve with regular rehabilitation exercises both in the early days after a stroke and long after they return home (Galvin et al. 2009). Indeed, even rehabilitation carried out years after a stroke can still lead to improvements. However, effective rehabilitation outside a clinical setting and without guidance can be difficult to achieve…

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[ARTICLE] Enhancing Visual Performance in Individuals with Cortical Visual Impairment (Homonymous Hemianopsia): Tapping into Blindsight – Full Text PDF

Visual improvement of a subject with left homonymous hemianopsia visual field defect from right occipital traumatic brain injury: A) Before treatment; B) After treatment using augmented reality goggles.

Highlights

    Patients with occipital lobe damage may have blind areas in their visual field.

    Other non-cortical areas of the brain still process visual information.

    Modifying visual input can stimulate non-cortical visual processing areas.

    Augmented virtual reality goggles as a therapy for cortical blindness is proposed.


Abstract

Homonymous hemianopsia is a type of cortical blindness in which vision is lost completely or partially in the left half or the right half of the field of vision. It is prevalent in approximately 12% of traumatic brain injury and 35% of strokes. Patients often experience difficulty with activities such as ambulating, eating, reading, and driving. Due to the high prevalence of homonymous hemianopsia and its associated difficulties, it is imperative to find methods for visual rehabilitation in this condition. Traditional methods such as prism glasses can cause visual confusion and result in patient noncompliance. There is a large unmet medical need for improving this condition. In this article, we propose that modifying visual stimuli to activate non-cortical areas of visual processing, such as lateral geniculate nucleus and superior colliculus, may result in increased visual awareness. Presenting high contrast and low spatial frequency visual stimuli can increase visual detection in patients with cortical blindness, a phenomenon known as blindsight. Augmented virtual reality goggles have the potential to alter real-time visual input to high contrast and low spatial frequency images, possibly improving visual detection in the blind hemifield and providing an alternative therapy for homonymous hemianopsia.


Introduction

Cortical visual impairment comprises a significant component of strokes and traumatic brain injury. Cortical visual impairment includes homonymous hemianopsia, in which vision is lost completely or partially in the left half or the right half of the field of vision. Homonymous hemianopsia is prevalent in approximately 12% of traumatic brain injury and 35% of strokes [1], [2] and [3]. Individuals with this vision loss usually have difficulties with activities of daily living such as ambulating, eating, reading, and driving [4] and [5]. Due to the high prevalence of homonymous hemianopsia and its associated difficulties, it is imperative to find methods for visual rehabilitation in this condition. Traditional methods of visual rehabilitation for homonymous hemianopsia include fitting spectacles with prisms to shift the visual field from the blind hemifield to the intact visual field. This is accomplished by placing the base of the prism in the blind hemifield, which shifts the image toward the apex of the prism into the intact hemifield. Many patients discontinue treatment with prisms because the prisms may induce visual confusion and double vision[1], [2], [3] and [4]. Another technique used is to train individuals with hemianopsia to make quick eye movements in the direction of the blind hemifield, though there is not much evidence supporting efficacy [6]. Although these methods may provide some compensation for the visual field loss, they do not restore the impaired visual field. Accordingly, other methods of improving vision are needed.

Individuals with homonymous hemianopsia do not consciously see vision in the blind hemifield. However, there is evidence of a ‘blindsight’ phenomenon, whereby some affected individuals can detect objects in their blind visual field, albeit without conscious awareness of being able to see the object. Functional magnetic resonance imaging (fMRI) studies have indicated that visual processing occurs in other parts of the brain, such as the lateral geniculate nucleus (LGN) and superior colliculus (SC) (Fig. 1). Visual processing in these regions provides the neural network that enables patients with blindsight to see [7], [8], [9], [10] and [11]. Blindsight has been manipulated in some individuals to enhance visual awareness. Weiskrantz et. al studied a patient with homonymous hemianopsia and well-documented blindsight over a long period of time [7]. The patient reported increased awareness of visual stimuli in his blind visual field when the stimulus was presented with high contrast and low spatial frequency. Spatial frequency refers to the level of detail in an image appearing within a degree of the visual field. Temporal frequency, the number of times a stimulus is flashed within a second, also modulates detection. Multiple studies have shown that within a temporal frequency range of 5-20 Hz (cycles/second), detection of visual stimuli in a forced-choice test is significantly better than chance [7], [8], [9], [10] and [11]. The time of stimulus onset also affects the rate of detection. Patients with parietal lobe injury often cannot detect a visual stimulus in the neglected hemifield when it is presented simultaneously in the intact hemifield, but can detect the stimulus when it is presented by itself in the neglected hemifield only, a phenomenon known as visual extinction [12] and [13]. It is thought that visual extinction reflects an attentional deficit as opposed to primarily a sensory deficit, although this remains an area of active research [14]. Despite that visual extinction is primarily studied in patients with hemi-neglect, patients with hemianopsia also can have hemi-neglect from injury to both the occipital and parietal lobes [15]. Therefore, the relevant visual variables for increasing visual detection in hemianopsia are stimuli contrast, spatial frequency, temporal frequency and stimulus onset asynchrony.

Continue —>  Enhancing Visual Performance in Individuals with Cortical Visual Impairment (Homonymous Hemianopsia): Tapping into Blindsight

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[WEB SITE] List of 31 Common Epilepsy and Seizure Medications – Healthy resources

LIST OF 31 COMMON EPILEPSY AND SEIZURE MEDICATIONS

Get a Complete Understanding

Epilepsy is a disorder in which the brain sends abnormal signals, which can lead to seizures. Although seizures can occur for a variety of reasons, such as injury or sickness, epilepsy causes recurrent seizures. There are many types of epileptic seizures. Many of them can be treated with anti-seizure medications.

https://tbirehabilitation.files.wordpress.com/2016/01/man-woman-upset_3106.jpg?w=620

Anti-seizure medications are also known as antiepileptic drugs (AEDs). According to the National Institute of Neurological Disorders and Stroke (NINDS), there are more than 20 AEDs available through prescription. While there are many options in epilepsy treatment, your therapy choices will depend on your:

  • age
  • type of seizures
  • frequency of seizures
  • lifestyle
  • chances of pregnancy (in women)

Seizure medications are available in two types: narrow- and broad-spectrum AEDs. Some patients may need more than one medication to prevent epileptic seizures more effectively. It’s important to discuss the possibility of side effects, and even worsening seizures, with your doctor before starting any of these medications.

See average costs for the most common epilepsy medications »

Part 2 of 3: Narrow-Spectrum AEDs

Narrow-Spectrum AEDs

Narrow-spectrum AEDs are designed for specific types of seizures. These are the most appropriate medications if seizures occur in one specific part of the brain on a regular basis.

Carbamazepine (Carbatrol, Tegretol, Epitol, Equetro)

Carbamazepine is used to treat seizures that occur in the temporal lobe. It may also be helpful in treating secondary, partial, and refractory seizures. It is used for many other purposes, including pain and mood treatment. Carbamazepine interacts with many other drugs.

Clobazam (Frisium, Onfri)

Clobazam helps prevent absence, secondary, and partial seizures. It is a benzodiazepine, a drug class that is often used for sedation, sleep, and anxiety. According to the Epilepsy Foundation, this medication may be used in patients as young as 2 years old. It has recently been linked to a rare but potentially serious skin reaction.

Diazepam (Valium, Diastat)

Used to treat cluster seizures, diazepam can also be used to treat prolonged seizures. Diazepam is a benzodiazepine. It’s also used to treat anxiety, alcohol withdrawal, and more. The product Diastat is used rectally for life threatening seizures.

Divalproex (Depakote)

This medication is approved to help treat complex partial, absence, partial, and multiple seizure types. Divalproex increases availability of gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter. It may also be helpful for bipolar mania and migraines.

Eslicarbazepine Acetate (Aptiom)

This seizure drug is approved as additional (adjunctive) treatment for partial-onset seizures. Its action is thought to involve blockade of sodium channels.

Ethosuximide (Zarontin)

This AED is used to treat all forms of absence seizures. These also include atypical, childhood, and juvenile absence seizures. Ethosuxemide reduces the likelihood of seizures.

Gabapentin (Neurontin, Gralise, Gabarone)

Glabapentin is used to treat partial seizures. It may be preferable over other AEDs because the potential side effects are mild. The most common are dizziness and fatigue. Gabapentin is also widely used for several pain syndromes.

Lacosamide (Vimpat)

This medication is used for partial seizures. According to the Epilepsy Foundation, it is approved for patients ages 17 and older. Lacosamide may be prescribed orally or intravenously.

Perampanel (Fycompa)

Perampanel is used to treat complex, simple, and refractory seizures. The way it works is not fully understood. The medication is thought to affect glutamate receptors in the brain. Perampanel can cause serious of life-threatening psychiatric or behavioral adverse reactions.

Phenobarbital

This is one of the first and oldest seizure medications still used in the treatment of epilepsy. It can treat generalized seizures, partial seizures, and tonic-clonic seizures. Phenobarbital is a long-acting sedative drug with anticonvulsant action.

Phenytoin (Dilantin, Phenytek, and others)

Phenytoin is another old and prominent anti-epileptic drug on the market. It stabilizes neuronal membranes. It’s used in the treatment of complex, simple, and refractory seizures. Phenytoin is available in both capsule and liquid form.

Pregabalin (Lyrica)

This medication is used as additional (adjunctive) treatment for partial-onset seizures. Pregabalin is used more often to treat diabetic neuropathy or fibromyalgia.

Rufinamide (Banzel)

This medication is used as additional (adjunctive) treatment of seizures associated with Lennox-Gastaut syndrome. It can cause adverse effects like high rate of heart rhythm changes and drug interactions. These effects limit the use of this drug.

Tiagabine Hydrochloride (Gabitril)

This medication is used as additional (adjunctive) treatment for complex and simple partial seizures.

Oxcarbazepine (Trileptal)

Oxcarbasepine is used to treat call types of focal seizures. According to Panayiotopoulos, it can be used in adults and children as young as 2 years old.

Vigabatrin (Sabril)

This medication is used as additional (adjunctive) treatment for complex partial seizures. This medication is restricted in use. It must be prescribed and dispensed by prescribers and pharmacies registered with the program. It comes with possible serious adverse effects, including permanent vision loss.

Part 3 of 3: Broad-Spectrum AEDs

Broad-Spectrum AEDs

If you have more than one type of seizure, a broad-spectrum AED may be your best choice of treatment. These medications are designed to prevent seizures in more than one part of the brain, as opposed to the focalized effects of narrow-spectrum AEDs.

Clonazepam (Epitril, Klonopin, Rivotril)

Clonazepam is a long-acting benzodiazepine. It’s used to treat multiple types of seizures. This includes myoclonic, akinetic, and absence seizures. Klonopin is the most common brand name. Clonazepam is also used to treat several other non-epileptic disorders.

Ezogabine (Potiga)

This AED is used as an additional (adjunctive) treatment. It’s used for generalized seizures, refractory, and complex partial seizures. Ezogabine can cause vision abnormalities that can become vision loss over time. It’s reserved for patients who do not respond to other drugs.

Felbamate (Felbatol)

Felbamate is used to treat nearly all types of seizures in people who don’t respond to other therapy. It can be used as single therapy or in combination with other drugs. It is used when other therapies have failed.

Lamotrigine (Lamictal)

This medication may treat a wide range of epileptic seizures. It’s also sometimes used in the treatment of Lennox-Gastaut Syndrome. When you start lamotrigine, your dose is gradually increased. People on this drug must watch for rare skin reactions, which can be serious.

Lorazepam (Ativan)

Lorazepam is approved for use in status epilepticus (prolonged, critical seizure). Lorazepam is a benzodiazepine. It’s often used for anxiety and mild sedation, with a rapid onset of action. It’s available in oral tablets, liquid, and injectable forms.

Primidone (Mysoline)

Primidone is used to treat myoclonic, tonic-clonic, and focal seizures. This medication is also approved for the use in juvenile myoclonic epilepsy.

Topiramate (Topamax)

Used as single or in combination treatment for a variety of seizures, topiramate is only available in its brand-name form Topamax. It has several actions. Topiramate is also used to treat migraine. It may also cause headache in some patients.

Levetiracetam (Keppra)

Levetiracetam is considered first line therapy for generalized and partial seizures, atypical, absence and other types of seizures. According to Panayiotopoulos, this promising drug can be used to treat all focal or generalized, idiopathic, or symptomatic epilepsy in people of all ages. It is also considered one of the drugs most free from adverse reactions.

Zonisamide (Zonegran)

Zonisamide is used as additional (adjuctive) treatment in partial seizures and other types of epilepsy. This drug has been shown to be effective in treating a range of epilepsy and seizure types. However, it comes with many potentially serious adverse reactions.

Valproic Acid

Valproic acid is a common AED. It’s approved to treat most seizures on its own or in combination treatment. Valproic acid increases the availability of gamma-aminobutryic acid (GABA). GABA is an inhibitory neurotransmitter to brain neurons. Valproic acid is also used to treat mood disorders or migraine. It is available in the following brands:

  • Depacon
  • Depakene
  • Depakine
  • Depakote
  • Depakote Sprinkles
  • Stavzor

Source: List of 31 Common Epilepsy and Seizure Medications – Healthy resources

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[WEB SITE] Epilepsy: Diagnosis & Tests – WebMD

 

Epilepsy Health Center

Diagnosis & Tests

How is epilepsy diagnosed? Since different types of seizures respond to different treatments, your doctor will ask about family history and request several tests.

Diagnosis

This outline will help prepare you to discuss your seizures with a doctor.

Tests

This test tracks electrical signals from the brain.

There are a number of blood tests that may be recommended as part of your epilepsy diagnosis and treatment.

A positron emission tomography (PET) scan may be used to locate the part of the brain that is causing seizures.

One test for epilepsy is a spinal tap — also called a lumbar puncture — a procedure in which the fluid surrounding the spinal cord (called the cerebrospinal fluid or CSF) is withdrawn through a needle and examined in a lab.

Source: Epilepsy: Diagnosis & Tests

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[Book Review] Cognitive Behavior Therapy for Depressed Adolescents: A Practical Guide to Management and Treatment – Google Books

Cognitive Behavior Therapy for Depressed Adolescents provides clinicians, clinical supervisors, and researchers with a comprehensive understanding of etiological pathways as well as current CBT approaches for treating affected adolescents.

Chapters guide readers from preparations for the first session and clinical assessment to termination and relapse prevention, and each chapter includes session transcripts to provide a more concrete sense of what it looks like to implement particular CBT techniques with depressed teens. In-depth discussions of unique challenges posed by working with depressed teens, as well as ways to address these issues, also are provided.

Source: Cognitive Behavior Therapy for Depressed Adolescents: A Practical Guide to … – Randy P. Auerbach, Christian A. Webb, Jeremy G. Stewart – Google Books

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