Archive for December, 2016

[WEB SITE] What is neuroplasticity?

For most of the 20th century, medical science assumed the brain was a static organ.  Knowledge processing and intelligence were considered permanent genetic attributes that could not change.  Schools often created a caste system: students labeled as slow were assumed to stay slow and high achieving students were kept to high standards with no room for shortcomings.

Modern neuroscience identifies a very different reality.  Rather than acting as static organs, our brains change as people acquire experience and knowledge.

Learning is more than just stuffing a brain with knowledge to be processed in a set way.

Neuropsychiatrists like Eric Kanel discovered that learning literally changed brain structure.  No one was limited by DNA: brains rewired as people learned, suffered trauma or injury, or experienced new situations.  With the right stimuli, a brain could improve processing ability and heal from injury.

This process of stimuli is known as neuroplasticity and its discovery has revolutionized the treatment of brain injury, mental illness and learning disabilities.

What is neuroplasticity?

Neuroplasticity describes the formation of new neural connections.  This compensates for injury and disease or aids adaptation to new situations.  For example, if a stroke damages the right side of the brain, with proper stimuli, the brain can start compensating for this injury by forming neural connections with the left side.

This process is termed “axonal sprouting” as the undamaged axons (nerve fibers) grow new endings to reconnect severed pathways or develop new pathways.

The process is similar to the creation of a new hiking trail when an original trail gets destroyed.  The new trail arrives at the destination but in a different way.  The end result is still the same.

Stimulating neuroplasticity

As Dr. McCleary states, the more thinking, the better functioning.  This is welcome news to those fearful of dwindling function as they age.  Those who suffer a brain injury or learning disability are also relieved that with the right exercise, they can improve their functioning.

Today, neuroplasticity has developed into a way to improve memory, reading, and other foundational brain skills.  This often contain a series of “brain exercises” to accomplish that task.  This is an example of positive neuroplasticity.

Neuroplasticity and Learning Disorders

Neuroplasticity is relevant to learning disorders in two ways.  One, it explains how past experiences can affect learning disabilities.  Research indicates that learning disabilities have a genetic component but may also intensify with the wrong stimulation.  Punishing a child for failure to perform to standards, or a history of abuse, increases the fear response, which may worsen the disability. However, home environments rich with positive stimulation may help children function better.

Two, neuroplasticity is also an effective response to learning disorders.  Children and adults who suffer from these challenges do not lack intelligence or even the desire to do well.  They simply have brains that are wired differently or inefficently.  With a combination of guidance and cognitive exercises based in theories regarding neuroplasticity, students can effectively change their brain structure so that the learning disability is barely noticeable or even disappears.  By activily targeting and developing the required areas of their brain they can build that new trail in their brain that leads them to the desired destination.

Neuroplasticity proves DNA is not destiny.  By defining the brain as a dynamic, not a static, organ those who suffer brain injury or learning disabilities have hope in meeting their life goals.

Source: What is neuroplasticity?

, , , ,

Leave a comment

[WEB SITE] Researchers study magnetic brain stimulation to improve symptoms after stroke – Fox News

Dr. Marcie Bockbrader adjusts an external brain stimulator on stroke survivor Debbie Hall at The Ohio State University Wexner Medical Center.

In an ongoing multi-center clinical trial, researchers are studying whether transcranial magnetic stimulation and occupational therapy can improve recovery for stroke patients.

For the study, patients are treated with transcranial magnetic stimulation, which stimulates a specific part of the brain using the Transcranial Magnetic Stimulator (TMS) by Nexstim (the technology developer who is funding the study), to help improve activity in the side of the body injured by stroke. The study currently has about 60 participants in 12 centers, but researchers are aiming to recruit 200 patients.

During a stroke, the blood vessel that carries oxygen and nutrients to the brain is blocked by a clot, called an ischemic stroke, or ruptures, known as a hemorrhagic stroke, depriving part of the brain from blood and oxygen. This leads to brain cell death and lasting deficits, which can include changes in speech, as well as vision and memory problems.

A patient may also lose feeling and movement in one side of their body due to decreased activity and function in the side of the brain injured by stroke.

The decrease in activity is similar to “a negative feedback loop, such that the less activity that those neurons have, the harder it is for them to recover function— and the greater the activity on the healthier side of the brain,” principal investigator Dr. Marcie Bockbrader, assistant professor of physical medicine and rehabilitation at The Ohio State University Wexner Medical Center, told FoxNews.com.

“This imbalance actually prevents— to some extent and to some people— the recovery of function on the injured side,” she said.

One therapy to address this imbalance is to physically constrain the healthy side of the body to allow the injured side of the brain and body to express itself.

While not all stroke patients experience this imbalance, a large proportion does. The study authors intend to demonstrate that delivering inhibitory stimulation to the healthy side of the brain combined with occupational therapy sessions, prompts increased activity on the injured side of the brain— and results in better function on the side of the body weakened by stroke.

Previous studies have shown brain stimulation alone does not provide enough benefit, so combining the process with therapy is key, Bockbrader said.

To participate, patients must have had a stroke within three to 12 months of enrollment, and have some one-sided upper-limb deficits but still have some upper-limb function in order to do the occupational therapy exercises.

Bockbrader noted that researchers have been selective and, to avoid confounding variables, can’t accept people with severe deficits, multiple sclerosis and spinal fusion. Patients must be close enough to their study center to go in three times a week to receive their therapies over the six-week course.

Because most health insurance covers only three months’ worth of therapy, researchers have found success recruiting at physical and occupational therapy sites. The study provides free therapy for six weeks for all participants.

“Everybody benefits, whether or not there’s added benefit from brain stimulation. That’s a bonus,” Bockbrader said.

For the double-blind, randomized trial, participants undergo six weeks of the combination of brain stimulation and occupational therapy. Half of the group receives sham stimulation and the other receives active stimulation. Once the data is collected across all the sites, researchers will reveal participants’ information and evaluate their functional ability to use the arm on their weaker side. Bockbrader expects the study to continue for another year or two as they gather data.

“What this would tell us is if the brain stimulation is working more than just therapy alone,” Bockbrader said, “making the neural ‘pop’ that is needed to change and increase their activity on the injured side of the brain … by suppressing the healthy side of the brain.”

The TMS treatment
Once participants are accepted into the study, an MRI scan of the brain is taken to understand the motor areas affected so researchers can target the magnetic pulse. The pulse is strong enough to illicit a twitch in the person’s healthy arm, so researchers know they’re aiming for the part of the healthy side of the brain assisting with motor function of the arm or hand.

“We can get something like 2 millimeter accuracy when we’re delivering 900 stimulation pulses over the course of 15 minutes, so it’s a 3D targeting within the brain based on the individual patient’s motor area for their hand,” Bockbrader said. There is also an orientation rotational component so researchers know the magnet is oriented in a way that maximally stimulates the correct neurons.

Participants sit in a comfortable reclining chair during the treatment. Once their stimulation intensity is determined, the Nexstim device is placed next to the head against the patient’s scalp, and delivers rapid magnetic pulses that go directly to their motorcortex to inhibit activity on the healthy side. A tracker on the patient’s forehead and an infrared sensing system tells the device’s navigation system if the pulses are on target, or if the Nexstim coil needs to be moved.  After 15 minutes, the patient is done and goes on to the occupational therapy session.

The stimulation threshold is dependent on the state of the brain at the time, which means that each time a patient comes in for his appointment, it is recalibrated to get the same amount of motor response each time. Eventually, researchers hope to be able to prescribe individual patients a specific strength of pulse, for a specific duration of time in a particular brain area.

Researchers re-examine patients six months after treatment to see whether the benefits are sustained.

TMS beyond stroke rehabilitation
Researchers hope that future phase III research will show enough evidence that the brain stimulation therapy can be adopted as a way to help people who have persistent deficiencies after a stroke.

The therapy can also potentially be pointed at any part of the brain that needs to be modulated after a stroke.  Noninvasive brain stimulation may also be useful for non-stroke related issues, such as fatigue, attention, and mood, Bockbrader said.

“I also see patients with traumatic brain injury and the protocols are similar across brain injury types…. So you can apply some of the technology to problems that result from brain injuries of different types,” she said.

One unknown is whether the therapy would work when administered beyond a year after stroke incidence.

“Theoretically it seems possible, but until we test… we just don’t know,” Bockbrader said. “[After a year] the spontaneous recovery period from stroke is essentially over, so if we could reinstitute a state of being more receptive through therapies to drive plasticity, that would improve function and drive recovery.”

Once the treatment is approved by the Food and Drug Administration (FDA), Bockbrader expects it would be marketed immediately in the clinical setting.

“From my point of view as a clinician, that’s what’s important— what we do in terms of man on the street,” she said. “Can they get this to help them get better? We want to make it more widely available.”

Source: Researchers study magnetic brain stimulation to improve symptoms after stroke | Fox News

, , , ,

Leave a comment

[VIDEO] Mirror Therapy

Your brain can be tricked! 🙂

He thought the rubber hand was his own hand, after getting his real and rubber hand stroked simultaneously.
He pulled his own hand away, when the rubber hand gets hit by a fork! 🙂
Amazing, right?

, , , , , ,

Leave a comment

[ARTICLE] Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation – Full Text

Stroke patients with severe motor deficits of the upper extremity may practice rehabilitation exercises with the assistance of a multi-joint exoskeleton. Although this technology enables intensive task-oriented training, it may also lead to slacking when the assistance is too supportive. Preserving the engagement of the patients while providing “assistance-as-needed” during the exercises, therefore remains an ongoing challenge. We applied a commercially available seven degree-of-freedom arm exoskeleton to provide passive gravity compensation during task-oriented training in a virtual environment. During this 4-week pilot study, five severely affected chronic stroke patients performed reach-to-grasp exercises resembling activities of daily living. The subjects received virtual reality feedback from their three-dimensional movements. The level of difficulty for the exercise was adjusted by a performance-dependent real-time adaptation algorithm. The goal of this algorithm was the automated improvement of the range of motion. In the course of 20 training and feedback sessions, this unsupervised adaptive training concept led to a progressive increase of the virtual training space (p < 0.001) in accordance with the subjects’ abilities. This learning curve was paralleled by a concurrent improvement of real world kinematic parameters, i.e., range of motion (p = 0.008), accuracy of movement (p = 0.01), and movement velocity (p < 0.001). Notably, these kinematic gains were paralleled by motor improvements such as increased elbow movement (p = 0.001), grip force (p < 0.001), and upper extremity Fugl-Meyer-Assessment score from 14.3 ± 5 to 16.9 ± 6.1 (p = 0.026). Combining gravity-compensating assistance with adaptive closed-loop feedback in virtual reality provides customized rehabilitation environments for severely affected stroke patients. This approach may facilitate motor learning by progressively challenging the subject in accordance with the individual capacity for functional restoration. It might be necessary to apply concurrent restorative interventions to translate these improvements into relevant functional gains of severely motor impaired patients in activities of daily living.

Introduction

Despite their participation in standard rehabilitation programs (Jørgensen et al., 1999; Dobkin, 2005), restoration of arm and hand function for activities of daily living is not achieved in the majority of stroke patients. In the first weeks and months after stroke, a positive relationship between the dose of therapy and clinically meaningful improvements has been demonstrated (Lohse et al., 2014; Pollock et al., 2014). In stroke patients with long-standing (>6 months) upper limb paresis, however, treatment effects were small, with no evidence of a dose-response effect of task-specific training on the functional capacity (Lang et al., 2016). This has implications for the use of assistive technologies such as robot-assisted training during stroke rehabilitation. These devices are usually applied to further increase and standardize the amount of therapy. They have the potential to improve arm/hand function and muscle strength, albeit currently available clinical trials provide on the whole only low-quality evidence (Mehrholz et al., 2015). It has, notably, been suggested that technology-assisted improvements during stroke rehabilitation might at least partially be due to unspecific influences such as increased enthusiasm for novel interventions on the part of both patients and therapists (Kwakkel and Meskers, 2014). In particular, a comparison between robot-assisted training and dose-matched conventional physiotherapy in controlled trials revealed no additional, clinically relevant benefits (Lo et al., 2010; Klamroth-Marganska et al., 2014). This might be related to saturation effects. Alternatively, the active robotic assistance might be too supportive when providing “assistance-as-needed” during the exercises (Chase, 2014). More targeted assistance might therefore be necessary during these rehabilitation exercises to maintain engagement without compromising the patients’ motivation; i.e., by providing only as much support as necessary and as little as possible (Grimm and Gharabaghi, 2016). In this context, passive gravity compensation with a multi-joint arm exoskeleton may be a viable alternative to active robotic assistance (Housman et al., 2009; Grimm et al., 2016a). In severely affected patients, performance-dependent, neuromuscular electrical stimulation of individual upper limb muscles integrated in the exoskeleton may increase the range of motion even further (Grimm and Gharabaghi, 2016; Grimm et al., 2016b). These approaches focus on the improvement of motor control, which is defined as the ability to make accurate and precise goal-directed movements without reducing movement speed (Reis et al., 2009; Shmuelof et al., 2012), or using compensatory movements (Kitago et al., 2013, 2015). Functional gains in hemiparetic patients, however, are often achieved by movements that aim to compensate the diminished range of motion of the affected limb (Cirstea and Levin, 2000; Grimm et al., 2016a). Although these compensatory strategies might be efficient in short-term task accomplishment, they may lead to long-term complications such as pain and joint-contracture (Cirstea and Levin, 2007; Grimm et al., 2016a). In this context, providing detailed information about how the movement is carried out, i.e., the quality of the movement, is more likely to recover natural movement patterns and avoid compensatory movements, than to provide information about movement outcome only (Cirstea et al., 2006; Cirstea and Levin, 2007; Grimm et al., 2016a). This feedback, however, needs to be provided implicitly, since explicit information has been shown to disrupt motor learning in stroke patients (Boyd and Winstein, 2004, 2006; Cirstea and Levin, 2007). Information on movement quality has therefore been incorporated as implicit closed-loop feedback in the virtual environment of an exoskeleton-based rehabilitation device (Grimm et al., 2016a). Specifically, the continuous visual feedback of the whole arm kinematics allowed the patients to adjust their movement quality online during each task; an approach closely resembling natural motor learning (Grimm et al., 2016a).

Along these lines, virtual reality and interactive video gaming have emerged as treatment approaches in stroke rehabilitation (Laver et al., 2015). They have been used as an adjunct to conventional care (to increase overall therapy time) or compared with the same dose of conventional therapy. These studies have demonstrated benefits in improving upper limb function and activities of daily living, albeit currently available clinical trials tend to provide only low-quality evidence (Laver et al., 2015). Most of these studies were conducted with mildly to moderately affected patients. In the remaining patient group with moderate to severe upper limp impairment, the intervention effects were more heterogeneous and affected by the impairment level, with either no or only modest additional gains in comparison to dose-matched conventional treatments (Housman et al., 2009; Byl et al., 2013; Subramanian et al., 2013).

With respect to the restoration of arm and hand function in severely affected stroke patients in particular, there is still a lack of evidence for additional benefits from technology-assisted interventions for activities of daily living. The only means of providing such evidence is by sufficiently powered, randomized and adequately controlled trials (RCT).

However, such high-quality RCT studies require considerable resources. Pilot data acquired earlier in the course of feasibility studies may provide the rationale and justification for later large-scale RCT. Such studies therefore need to demonstrate significant improvements, with functional relevance for the participating patients. Then again, costly RCT can be avoided when innovative interventions prove to be feasible but not effective with regard to the treatment goal, i.e., that they do not result in functionally relevant upper extremity improvements in severely affected stroke patients.

One recent pilot study, for example, applied brain signals to control an active robotic exoskeleton within the framework of a brain-robot interface (BRI) for stroke rehabilitation. This device provided patient control over the training device via motor imagery-related oscillations of the ipsilesional cortex (Brauchle et al., 2015). The study illustrated that a BRI may successfully link three-dimensional robotic training to the participant’s effort. Furthermore, the BRI allowed the severely impaired stroke patients to perform task-oriented activities with a physiologically controlled multi-joint exoskeleton. However, this approach did not result in significant upper limb improvements with functional relevance for the participating patients. This training approach was potentially too challenging and may even have frustrated the patients (Fels et al., 2015). The patients’ cognitive resources for coping with the mental load of performing such a neurofeedback task must therefore be taken into consideration (Bauer and Gharabaghi, 2015a; Naros and Gharabaghi, 2015). Mathematical modeling on the basis of Bayesian simulation indicates that this might be achieved when the task difficulty is adapted in the course of the training (Bauer and Gharabaghi, 2015b). Such an adaptation strategy has the potential to facilitate reinforcement learning (Naros et al., 2016b) by progressively challenging the patient (Naros and Gharabaghi, 2015). Recent studies explored automated adaptation of training difficulty in stroke rehabilitation of less severely affected patients (Metzger et al., 2014; Wittmann et al., 2015). More specifically, both robot-assisted rehabilitation of proprioceptive hand function (Metzger et al., 2014) and inertial sensor-based virtual reality feedback of the arm (Wittmann et al., 2015) benefit from assessment-driven adjustments of exercise difficulty. Furthermore, a direct comparison between adaptive BRI training and non-adaptive training (Naros et al., 2016b) or sham adaptation (Bauer et al., 2016a) in healthy patients revealed the impact of reinforcement-based adaptation for the improvement of performance. Moreover, the exercise difficulty has been shown to influence the learning incentive during the training; more specifically, the optimal difficulty level could be determined empirically while disentangling the relative contribution of neurofeedback specificity and sensitivity (Bauer et al., 2016b).

In the present 4-week pilot study, we combined these approaches and customized them for the requirements of patients with severe upper extremity impairment by applying a multi-joint exoskeleton for task-oriented arm and hand training in an adaptive virtual environment. Notably, due to the severity of their impairment, these patients were not able to practice the reach-to-grasp movements without the exoskeleton. The set-up was, however, limited to pure antigravity support, i.e., it provided passive rather than active assistance. Furthermore, it tested the feasibility of closed-loop online adaptation of exercise difficulty and aimed at automated progression of task challenge.

Continue —> Frontiers | Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation | Neuroprosthetics

www.frontiersin.org

Figure 1. Training set-up with the exoskeleton (upper row) and the provided visual feedback in virtual reality (lower row).

, , , , , , , , , , , ,

Leave a comment

[ARTICLE] Perceived ability to perform daily hand activities after stroke and associated factors: a cross-sectional study – Full Text

Abstract

Background

Despite that disability of the upper extremity is common after stroke, there is limited knowledge how it influences self-perceived ability to perform daily hand activities. The aim of this study was to describe which daily hand activities that persons with mild to moderate impairments of the upper extremity after stroke perceive difficult to perform and to evaluate how several potential factors are associated with the self-perceived performance.

Methods

Seventy-five persons (72 % male) with mild to moderate impairments of the upper extremity after stroke (4 to 116 months) participated. Self-perceived ability to perform daily hand activities was rated with the ABILHAND Questionnaire. The perceived ability to perform daily hand activities and the potentially associated factors (age, gender, social and vocational situation, affected hand, upper extremity pain, spasticity, grip strength, somatosensation of the hand, manual dexterity, perceived participation and life satisfaction) were evaluated by linear regression models.

Results

The activities that were perceived difficult or impossible for a majority of the participants were bimanual tasks that required fine manual dexterity of the more affected hand. The factor that had the strongest association with perceived ability to perform daily hand activities was dexterity (p < 0.001), which together with perceived participation (p = 0.002) explained 48 % of the variance in the final multivariate model.

Conclusion

Persons with mild to moderate impairments of the upper extremity after stroke perceive that bimanual activities requiring fine manual dexterity are the most difficult to perform. Dexterity and perceived participation are factors specifically important to consider in the rehabilitation of the upper extremity after stroke in order to improve the ability to use the hands in daily life.

Background

Disability of the upper extremity is common after stroke and almost 50 % of those affected have remaining impairments more than three months post-stroke [1, 2]. The impairments often lead to difficulties in performing daily hand activities [3], especially those that require the use of both hands, i.e., bimanual activities [4]. The ability to perform bimanual activities is therefore an important goal in stroke rehabilitation, regardless of which hand that is affected [5].

The ability to perform daily activities can be objectively assessed by observations of different tasks in a standardized environment or by patient-reported questionnaires. The advantage of using questionnaires is that they often provide a better understanding of an individual’s self-reported everyday difficulties and thereby enable clinicians to design more individually targeted rehabilitation interventions [6]. One questionnaire that is recommended for persons with disability of the upper extremity after stroke is the ABILHAND Questionnaire [4, 7, 8]. It assesses self-perceived ability to perform daily bimanual activities. Previous studies have focused on evaluating the psychometric properties of the ABILHAND [4, 8], but no study has thoroughly described which activities persons in a stable phase post stroke perceive difficult to perform.

In order to improve functioning of the upper extremity after stroke, it is important to understand which factors affect self-perceived ability to perform daily hand activities. Previous studies have shown that single factors, such as motor function, muscle strength, spasticity, somatosensation, dexterity, perceived participation and life satisfaction are moderately to strongly associated with the perceived ability [4, 9, 10, 11, 12, 13, 14, 15, 16, 17]. However, as several factors simultaneously may influence the ability to perform daily hand activities there is a need to understand how these factors are associated with the performance. To the best of our knowledge, only one study [14] has evaluated this association in persons in a stable phase after stroke. In that study by Harris and Eng [14], muscle strength, spasticity, somatosensation and pain were included in multivariate analyses and the authors found that muscle strength in the upper extremity and spasticity were the strongest contributing factors to the perceived ability to use the hands in daily activities. However, dexterity was omitted as a potentially associated factor in the analysis, which was addressed as a limitation of the study. In other studies, gender, dominance of the affected upper extremity, and social and vocational situations have been shown to be important factors for overall functioning after stroke [18, 19, 20, 21]. However, it is unclear how these factors are associated with the self-perceived ability.

Taken together, despite that disability of the upper extremity is common after stroke there is limited knowledge of which daily activities that are perceived difficult to perform and which factors that affect the self-perceived performance. The majority of previous studies have evaluated how single or few factors are associated with perceived daily hand activities. Thus, there is a need for more studies that take several factors into account simultaneously.

The aim of this study was to evaluate a) which daily activities persons with mild to moderate impairments of the upper extremity after stroke perceive difficult to perform and b) how several factors (age, gender, social and vocational situation, affected hand, upper extremity pain, spasticity, grip strength, somatosensation, manual dexterity, perceived participation and life satisfaction) are associated with the self-perceived performance.

Continue —> Perceived ability to perform daily hand activities after stroke and associated factors: a cross-sectional study | BMC Neurology | Full Text

, , , , , , , , , , , , , , , ,

Leave a comment

[WEB SITE] How Bad science misled millions with chronic fatigue syndrome patients

If your doctor diagnoses you with chronic fatigue syndrome, you’ll probably get two pieces of advice: Go to a psychotherapist and get some exercise. Your doctor might tell you that either of those treatments will give you a 60 percent chance of getting better and a 20 percent chance of recovering outright. After all, that’s what researchers concluded in a 2011 study published in the prestigious medical journal the Lancet, along with later analyses.

Problem is, the study was bad science.

And we’re now finding out exactly how bad.

Under court order, the study’s authors for the first time released their raw data earlier this month. Patients and independent scientists collaborated to analyze it and posted their findings Wednesday on Virology Blog, a site hosted by Columbia microbiology professor Vincent Racaniello.

The analysis shows that if you’re already getting standard medical care, your chances of being helped by the treatments are, at best, 10 percent. And your chances of recovery? Nearly nil.

The new findings are the result of a five-year battle that chronic fatigue syndrome patients — me among them — have waged to review the actual data underlying that $8 million study. It was a battle that, until a year ago, seemed nearly hopeless.

When the Lancet study, nicknamed the PACE trial, first came out, its inflated claims made headlines around the world. “Got ME? Just get out and exercise, say scientists,” wrote the Independent, using the acronym for the international name of the disease, myalgic encephalomyelitis. (Federal agencies now call it ME/CFS.) The findings went on to influence treatment recommendations from the CDC, the Mayo Clinic, Kaiser, the British National Institute for Health and Care Excellence, and more.

But patients like me were immediately skeptical, because the results contradicted the fundamental experience of our illness: The hallmark of ME/CFS is that even mild exertion can increase all the other symptoms of the disease, including not just profound fatigue but also cognitive deficits, difficulties with blood pressure regulation, unrestorative sleep, and neurological and immune dysfunction, among others.

Soon after I was diagnosed in 2006, I figured out that I had to rest the moment I thought, “I’m a little tired.” Otherwise, I would likely be semi-paralyzed and barely able to walk the next day.

The researchers argued that patients like me, who felt sicker after exercise, simply hadn’t built their activity up carefully enough. Start low, build slowly but steadily, and get professional guidance, they advised. But I’d seen how swimming for five minutes could sometimes leave me bedbound, even if I’d swum for 10 minutes without difficulty the day before. Instead of trying to continually increase my exercise, I’d learned to focus on staying within my ever-changing limits — an approach the researchers said was all wrong.

A disease ‘all in my head’?

The psychotherapy claim also made me skeptical. Talking with my therapist had helped keep me from losing my mind, but it hadn’t kept me from losing my health. Furthermore, the researchers weren’t recommending ordinary psychotherapy — they were recommending a form of cognitive behavior therapy that challenges patients’ beliefs that they have a physiological illness limiting their ability to exercise. Instead, the therapist advises, patients need only to become more active and ignore their symptoms to fully recover.

In other words, while the illness might have been triggered by a virus or other physiological stressor, the problem was pretty much all in our heads.

By contrast, in the American research community, no serious researchers were expressing doubts about the organic basis for the illness. Immunologists found clear patterns in the immune system, and exercise physiologists were seeinghighly unusual physiological changes in ME/CFS patients after exercise.

I knew that the right forms of psychotherapy and careful exercise could help patients cope, and I would have been thrilled if they could have cured me. The problem was that, so far as I could tell, it just wasn’t true.

A deeply flawed study

Still, I’m a science writer. I respect and value science. So the PACE trial left me befuddled: It seemed like a great study — big, controlled, peer-reviewed — but I couldn’t reconcile the results with my own experience.

So I and many other patients dug into the science. And almost immediately we saw enormous problems.

Before the trial of 641 patients began, the researchers had announced their standards for success — that is, what “improvement” and “recovery” meant in statistically measurable terms. To be considered recovered, participants had to meet established thresholds on self-assessments of fatigue and physical function, and they had to say they felt much better overall.

But after the unblinded trial started, the researchers weakened all these standards, by a lot. Their revised definition of “recovery” was so loose that patients could get worse over the course of the trial on both fatigue and physical function and still be considered “recovered.” The threshold for physical function was so low that an average 80-year-old would exceed it.

In addition, the only evidence the researchers had that patients felt better was that patients said so. They found no significant improvement on any of their objective measures, such as how many patients got back to work, how many got off welfare, or their level of fitness.

But the subjective reports from patients seemed suspect to me. I imagined myself as a participant: I come in and I’m asked to rate my symptoms. Then, I’m repeatedly told over a year of treatment that I need to pay less attention to my symptoms. Then I’m asked to rate my symptoms again. Mightn’t I say they’re a bit better — even if I still feel terrible — in order to do what I’m told, please my therapist, and convince myself I haven’t wasted a year’s effort?

Many patients worked to bring these flaws to light: They wrote blogs; they contacted the press; they successfully submitted carefully argued letters and commentaries to leading medical journals. They even published papers in peer-reviewed scientific journals.

They also filed Freedom of Information Act requests to gain access to the trial data from Queen Mary University of London, the university where the lead researcher worked. The university denied most of these, some on the grounds that they were “vexatious.”

Critics painted as unhinged

The study’s defenders painted critics as unhinged crusaders who were impeding progress for the estimated 30 million ME/CFS patients around the world. For example, Richard Horton, the editor of the Lancet, described the trial’s critics as “a fairly small, but highly organised, very vocal and very damaging group of individuals who have, I would say, actually hijacked this agenda and distorted the debate so that it actually harms the overwhelming majority of patients.”

Press reports also alleged that ME/CFS researchers had received death threats, and they lumped the PACE critics in with the purported crazies.

While grieving for my fellow patients, I seethed at both the scientists and the journalists who refused to examine the trial closely. I could only hope that, eventually, PACE would drown under a slowly rising tide of good science, even if the scientific community never recognized its enormous problems.

more —> How Bad science misled millions with chronic fatigue syndrome patients | Private Medical

, , ,

Leave a comment

[WEB SITE] Electronic Magnifier (CCTV) | Screen Magnifier | CCTV | Magnifiers | Reading Magnifier | CCTV Systems

 

An electronic magnifier, also known as a video magnifier, combines traditional magnifying glass principles with innovative technology to help individuals with low vision to improve their ability to effectively see images on monitors or screens by changing the brightness, the contrast, and the magnification strength.

Scroll down or click to read more about “Electronic Magnifiers

Source: Electronic Magnifier (CCTV) | Screen Magnifier | CCTV | Magnifiers | Reading Magnifier | CCTV Systems

, , ,

Leave a comment

[ARTICLE] Development of Device and Serious Game Contents for the Multi-finger Rehabilitation – Full Text

Abstract
In modern society, with the increasing use of such compact devices as smart phones and computers, finger and hand mobility is very important for daily living. Generally, in the case where there is impaired motor function of the hands or fingers, rehabilitation involves boring repetitive exercises. In this study, serious games were implemented using a dynamometer which made it possible to measure grip width and finger grip strength according to the size of the hand. The game was developed based on rhythm games, and, by selectively training the fingers that need rehabilitation, it is possible to improve a variety of functions such as finger agility, power and endurance. In addition, by analyzing data changes during the training process, the intensity of the rehabilitation can be quantitatively assessed. Furthermore, it provided users with an active and fun rehabilitation environment because they could choose and use their own desired music files during their rehabilitation.

Download Full Text PDF

, , , , ,

Leave a comment

[TEDx Talk] After watching this, your brain will not be the same | Lara Boyd | TEDxVancouver

 

In a classic research-based TEDx Talk, Dr. Lara Boyd describes how neuroplasticity gives you the power to shape the brain you want. Recorded at TEDxVancouver at Rogers Arena on November 14, 2015.

YouTube Tags: brain science, brain, stroke, neuroplasticity, science, motor learning, identity, TED, TEDxVancouver, TEDxVancouver 2015, Vancouver, TEDx, Rogers Arena, Vancouver speakers, Vancouver conference, ideas worth spreading, great idea,

Our knowledge of the brain is evolving at a breathtaking pace, and Dr. Lara Boyd is positioned at the cutting edge of these discoveries. In 2006, she was recruited by the University of British Columbia to become the Canada Research Chair in Neurobiology and Motor Learning. Since that time she has established the Brain Behaviour Lab, recruited and trained over 40 graduate students, published more than 80 papers and been awarded over $5 million in funding.

Dr. Boyd’s efforts are leading to the development of novel, and more effective, therapeutics for individuals with brain damage, but they are also shedding light on broader applications. By learning new concepts, taking advantage of opportunities, and participating in new activities, you are physically changing who you are, and opening up a world of endless possibility.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

, , , , , , , ,

Leave a comment

[TED Talk] Sandrine Thuret: You can grow new brain cells. Here’s how

Can we, as adults, grow new neurons? Neuroscientist Sandrine Thuret says that we can, and she offers research and practical advice on how we can help our brains better perform neurogenesis—improving mood, increasing memory formation and preventing the decline associated with aging along the way.

, , ,

Leave a comment

%d bloggers like this: