Archive for January, 2017

[REVIEW] Adverse events of tDCS and tACS: A review – Full Text

Highlights

  • No serious adverse effects have been reported in experiments using either tDCS or tACS.
  • Persistent adverse effects of tDCS are mainly skin problems; for tACS, none have been reported.
  • Further safety investigations are needed.

Abstract

Transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) have been applied to many research issues because these stimulation techniques can modulate neural activity in the human brain painlessly and non-invasively with weak electrical currents. However, there are no formal safety guidelines for the selection of stimulus parameters in either tDCS or tACS. As a means of gathering the information that is needed to produce safety guidelines, in this article, we summarize the adverse events of tDCS and tACS. In both stimulation techniques, most adverse effects are mild and disappear soon after stimulation. Nevertheless, several papers have reported that, in tDCS, some adverse events persist even after stimulation. The persistent events consist of skin lesions similar to burns, which can arise even in healthy subjects, and mania or hypomania in patients with depression. Recently, one paper reported a pediatric patient presenting with seizure after tDCS, although the causal relationship between stimulation and seizure is not clear. As this seizure is the only serious adverse events yet reported in connection with tDCS, tDCS is considered safe. In tACS, meanwhile, no persistent adverse events have been reported, but considerably fewer reports are available on the safety of tACS than on the safety of tDCS. Therefore, to establish the safety of tDCS and tACS, we need to scan the literature continuously for information on the adverse events of both stimulation techniques. Further safety investigations are also required.

1. Introduction

Since the first reports of transcranial direct current stimulation (tDCS) by Priori et al. (1998)) and Nitsche and Paulus, 2000, Nitsche and Paulus, 2001), tDCS has been applied to many research issues because it can modulate the neural networks in the human brain painlessly and non-invasively (Priori et al., 1998, Nitsche and Paulus, 2000, Nitsche and Paulus, 2001). In other words, tDCS can induce neural plasticity (Ugawa, 2012). Most of its adverse effects are mild and disappear soon after stimulation, but several papers have reported that some adverse effects, most commonly skin problems, can persist even after stimulation. Recently, since the invention of transcranial alternating current stimulation (tACS) by Antal et al. (2008)), tACS has also been applied in research for the modulation of neural activity through the entrainment on brain oscillations (Antal et al., 2008, Antal and Herrmann, 2016). As in tDCS, the adverse effects of tACS are mild and disappear just after stimulation. Yet there have been far fewer papers on safety issues or adverse events of tACS as compared to tDCS. To date, there are no formal safety guidelines for the selection of stimulus parameters in either tDCS or tACS (Fertonani et al., 2015). Therefore, we aim to summarize the adverse events of tDCS and tACS in this review. At present, the safety and ethical issues of both stimulation techniques should be considered by each institution due to the lack of certainty about their risks. This review may provide some useful information for these considerations. In addition, this review is expected to be useful for the establishment of safety guidelines in the near future.

Continue —> Adverse events of tDCS and tACS: A review – Clinical Neurophysiology Practice

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[ARTICLE] Adaptation, perceptual learning, and plasticity of brain functions – Full Text

Abstract

The capacity for functional restitution after brain damage is quite different in the sensory and motor systems. This series of presentations highlights the potential for adaptation, plasticity, and perceptual learning from an interdisciplinary perspective. The chances for restitution in the primary visual cortex are limited. Some patterns of visual field loss and recovery after stroke are common, whereas others are impossible, which can be explained by the arrangement and plasticity of the cortical map. On the other hand, compensatory mechanisms are effective, can occur spontaneously, and can be enhanced by training. In contrast to the human visual system, the motor system is highly flexible. This is based on special relationships between perception and action and between cognition and action. In addition, the healthy adult brain can learn new functions, e.g. increasing resolution above the retinal one. The significance of these studies for rehabilitation after brain damage will be discussed.

Introduction by S. Trauzettel-Klosinski

This symposium highlighted the potential for learning and re-learning after visual and motor cortex lesions in the adult brain from an interdisciplinary perspective. We considered mechanisms such as adaptation, plasticity, and perceptual learning of different brain functions, as well as their applications for rehabilitation in patients with brain damage. Additionally, the potential for visual learning in the normal human brain was demonstrated.

In the visual system, the potential for recovery in the primary visual cortex is limited (part 1 by Jonathan Horton). Visual field defects caused by embolic stroke are constrained by the organization of the blood supply of the occipital lobe with respect to the retinotopic map. In terms of the arrangement and plasticity of the cortical map, it will be explained why some patterns of visual field loss and recovery following stroke are common, whereas others are essentially impossible. This is especially true along a visual field strip of constant width along the vertical meridian.

While the restitutive capacities of the primary visual cortex are limited, compensatory mechanisms can be very effective (part 2 by Susanne Trauzettel-Klosinski). They can occur spontaneously and can further be enhanced by training. In hemianopia, for example, fixational eye movements and scanning saccades can shift the visual field border towards the hemianopic side and improve spatial orientation and mobility.

In contrast to the visual system, the human motor system is highly flexible (part 3 by Theo Mulder). It is updated continuously by itself on the basis of sensory input and activity. The plasticity of the motor system is based on a special relationship between perception and action, as well as between cognition and action. New approaches to rehabilitation, for example by motor imagery, give an outlook on future possibilities.

Additionally, the healthy adult brain can learn new visual functions (part 4 by Manfred Fahle), for example the enhancement of resolution, which is higher than that of the retina. These functions, especially hyperacuity, can also be trained.

The authors will present a summary for each of the four talks.

Part 1: visual field recovery after lesions of the occipital lobe by Jonathan C. Horton

Recently, I attended a 60-year-old woman who had a spontaneous left parietal hemorrhage (Fig. 1). She underwent an emergency craniotomy to evacuate the hematoma. Her main deficit was a severe aphasia, which improved slowly. Once she regained sufficient ability to communicate, she complained about her vision on the right side. Her examination showed a total, macula-splitting right homonymous hemianopia. She has made nearly a complete recovery from her stroke, except for this devastating visual field cut. It has made reading a chore, forced her to give up driving, and will prevent her from returning to her job. This is a common scenario: after surviving a neurological disaster, patients discover that vision loss represents their most serious and enduring deficit. Why does central vision loss persist, and remain so stubbornly resistant to treatment?
https://tbirehabilitation.files.wordpress.com/2017/01/417_2016_3580_fig1_html.gif?w=394&h=197

Fig. 1 CT scan showing an acute left parietal hematoma, causing a right homonymous hemianopia. A CT scan performed 5 months later shows damage to the left optic radiations. The visual field cut never recovered

The answer lies in the organization of the visual pathway from eye to cortex. Retinal ganglion cell axons that are responsible for conscious perception project to the lateral geniculate nucleus. It serves as a relay station, boosting the information content of outgoing spikes compared with incoming spikes by integrating and filtering retinal signals [1]. Geniculate neurons send their projection to layer 4 of the primary visual cortex. Simply by crossing a single synapse in the thalamus, retinal output is conveyed directly to the primary visual cortex. In a sense, the retino-geniculo-cortical pathway is the aorta of our visual system (Fig. 2). After initial processing in the primary visual cortex, signals are analyzed in surrounding cortical areas that are specialized for different attributes, allowing us to perceive the images that impinge upon our retinae.

https://tbirehabilitation.files.wordpress.com/2017/01/417_2016_3580_fig2_html.gif?w=520&h=359

Fig. 2 Retinal input is conveyed to the primary (striate) cortex by a two-neuron chain, crossing a single relay in the lateral geniculate nucleus. Injury at any point cuts off visual perception, although a small projection (green shading) from the lateral geniculate to area MT allows “blindsight” in patients with homonymous hemianopia caused by a post-chiasmal lesion (pink shading). After Polyak (1957)

Continue —> Adaptation, perceptual learning, and plasticity of brain functions | SpringerLink

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[WEB SITE] Hemianopsia and Driving: Are We Asking the Right Questions? – brainline.org

Laura K. Windsor, O.D., F.A.A.O.  and Richard L. Windsor, O.D., F.A.A.O, Hemianopsia.net

“All great truths begin as blasphemies.”
— George Bernard Shaw

To understand the issues of driving with a homonymous hemianopsia, we have to better define the question. Too often the question is presented as, “Can an individual with homonymous hemianopsia drive safely?” This is the wrong question! The question today should be “Which homonymous hemianopsia patients are safe to drive?” Many research studies have found that even without the kind of clinical patient selection criterion, adaptive devices, therapy and driver’s training that a potential hemianopsia driver should undergo, a significant portion of hemianopsia patients in these studies demonstrated that they may have potential to drive safely.

If we look at the group of all hemianopsia patients, those who are safe to drive will be a very small group. This is owing to the great variability of associated problems of cognition, visual neglect, visual perception, alertness and ability to compensate. No clinician or researcher would ever argue that all hemianopsia patients are safe to drive.

Let us look instead at a limited group of hemianopsia patients for whom the higher order deficits have been screened to rule out cognitive deficits, visual neglect, and poor processing speed. In this group visual field expanders have been prescribed where indicated and the patients trained with these devices and given scanning training. Then these patients have been screened with a behind-the-wheel driving evaluation, we would see a much smaller group. But within that group, would emerge a patients that could have the potential to return to driving.

It is less about the visual field

Another question I see that demonstrates a failure for some to understand where the problem resides is “How much visual field is required to drive safely?” As clinicians that have worked for many decades with hemianopsia patients, we have learned that the visual field defect is only a small part of the driving safety issue. It is usually about the constellation of problems from the brain injury and each individual’s ability to compensate.

While the type and size of visual fields are factors, the higher order cognitive functions are far more important to safe driving than the size of the visual field. These higher cognitive and perceptual functions determine if the patient can safely compensate. The real question should be expanded to, “On a case-by-case basis does this patient with an acquired brain injury from stroke, tumor, trauma or other cause, have the higher-level cognitive skills, compensatory skills, optical devices, experience, stamina driving skills and discipline to drive with a reduced visual field?”

All hemianopsia are not created equal!

Let us look at two patients with identical measurable visual field, both presenting with left homonymous hemianopsias. The first has an isolated stroke in the right occipital lobe no deficits other than the visual field loss. This patient has no visual neglect and no deficits in saccadic eye movements that would impair compensatory scanning and searching into the area of loss. With training and appropriate devices, this patient may have potential to return to safe driving. The second patient has an identical appearing left homonymous hemianopsia but from a stroke in a different location, the right parietal lobe. Thus this patient also has severe left visual neglect, impairments in saccadic eye movements and thus will never return to driving. If we only look at the visual field results, these patients look identical, but they are totally different cases.

If a state law looks only at the visual field loss to determine if driving is possible, they would treat both patients the same, denying them both the option of a driver’s license. While the second patient should not drive, this can needlessly devastate the first patient’s life, robbing the patient of independence, ability to get to work, and to lead an otherwise normal life.

How do we predict safety?

The other question we must ask is, “What tests and evaluations best predict safe driving and what are the potential weaknesses that must be addressed in training?” Various neuropsychological tests can give us information on who may have potential to drive safely. More research to establish which tests give us the most effective data is needed. Additionally, behind-the-wheel research studies continue to expand our information on the unique driving behaviors of the hemianopsia driver.

Driving, however, is a complex function. Prior experience, stamina, motivation, and discipline combined with visual status and mental functioning all can shape the impact on safety. After all the testing and treatments are completed to help select those who show potential to drive, a behind-the-wheel driving evaluation with a driving rehabilitator experienced with acquired brain injury and hemianopsia is needed. Only during the behind-the-wheel examination and training can the full complexity of driving be evaluated and training performed to improve specific skills like lane position, use of optical devices and mirrors.

The most important question is, “Have we learned to treat each person as a unique individual, understanding that impairment, disability and handicap are not one in the same?”

Should state laws prevent all Hemianopsia driving?

Setting an arbitrary visual field width to discriminate against all hemianopsia patients is now seen by many current researchers as a needless burden on the portion of hemianopsia patients that have the ability to return to safe driving. Below is what a number of researchers have observed:

As Dr. Eli Peli, Senior Scientist from Harvard’s Schepens Eye Research Institute stated in Driving With Confidence, A Practical Guide to Driving with Low Vision:

“It is clear that not all people with hemianopia function at the same level and many probably could not drive safely. However, a fair percentage of these patients may compensate for their visual loss to such an extent that they can drive as safely as any driver.”

In Automobile Driving Performance of Brain-Injured with Visual Field Defects , T Schulte, H Strasburger, E Muller-Oehring, E Kasten and B Sabel 1999, American Journal of Physical Medicine & Rehabilitation, researchers performed a driving simulator-based study of six hemianopsia patients and a similar size group of normally sighted. They summarized:

“Contrary to our expectations, the findings showed no reliable difference in the performance of visually impaired and the normally sighted subjects on a driving simulator. …Thus on a practical level our results indicate that the suspension of driving privileges for persons having visual field impairments may be unwarranted on the basis of visual field loss alone.”

In a study by Racette & Casson (1999), Visual field loss and driving performance: a retrospective study Abstracts of the Eighth International Conference Vision in Vehicles, they studied 13 homonymous hemianopsia patients and 7 homonymous quadranopsia patients. They determined those who were unsafe, those who need additional assessment, and those who were safe. Only 23% of the hemianopsia patients were found unsafe and none of the quadranopsia patients were deemed unsafe.

“Clearly, the evidence provided by these reports indicate that homonymous visual field defect and homonymous hemianopia by itself can not be an absolute and inevitable contra-indication for practical fitness to drive.”

A 2009 study, On-road driving performance by persons with hemianopia and quadrantanopia, Investigative Ophthalmology Vis Sci 50 (2) 2009, J. Wood, G. McGwin, J. Elgin, M. Vaphiades, R. Braswell, D. DeCarlo, L Kline, G Meek, K Searcy and C. Owsley studied 22 hemianopsia and 8 quadranopsia patients and a normal control group driving over a 14.1 mile course of city and interstate driving. Two back seat evaluators, who were masked to the status of the patient, evaluated the drivers. They found 100% of normal drivers were safe to drive and 73% of hemianopsia and 88% of quadranopsia patients were safe to drive.

The study concluded that:

“Some drivers with hemianopia or quadrantanopia are fit to drive compared with age-matched control drivers. Results call into question the fairness of governmental policies that categorically deny licensure to persons with hemianopia or quadrantanopia without the opportunity for on-road evaluation.”

Continued research is crucial to define all of the parameters of hemianoptic driving. Information from these studies helps us define the best candidate, the areas of weakness and will guide driving rehabilitation specialists in training these patients.

A study by Bower et al, from The Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, Driving with Hemianopia, I: Detection Performance in a Driving Simulator, published November 2009 in Investigative Ophthalmology and Visual Science, tested twelve hemianopsia patients without visual neglect or cognitive loss and twelve matched normals on a simulator test over a two hour period. The hemianopsia patients were tested without visual field expanding systems and they demonstrated significantly more difficulty in detection of suddenly appearing pedestrians on their impaired side inside the simulator.

There was great variability in pedestrian detection among the small group of 12 hemianopsia patients with older driver’s demonstrating lower rates. The authors of this study warned that simulator studies may not match results in real world driving and they further suggested that this also means we must look at each driving candidate individually. They stated:

“In determining fitness to drive for people with HH, the results underscore the importance of individualized assessments including evaluations of blind-side hazard detection.”

The same scientists now plan to do similar tests with patients using visual field expanders. Our years of work would support that the visual field expanders and training can help fill in detection of pedestrians in many patients, but more research is needed.

How could states regulate hemianopsia licensing?

It is clear from the research that we cannot make generalizations about the driving safety of all hemianoptic drivers. Thus simply removing visual field requirements could lead to hemianopsia drivers being licensed who have other cognitive or perceptual problems at make them unsafe.

States that still contain absolute prohibitions against driving with homonymous hemianopsias should consider removing these, and replacing them with a process to judge each patient individually based on current science. The process should include mandatory evaluation with a low vision specialist experienced in hemianopsia for evaluation and treatment followed by additional therapy/training as needed including occupational therapy if indicated. Then a behind-the-wheel driving evaluation and training as appropriate to each case with a certified driving rehabilitation specialist should be completed.

Then, the doctor with the report of the driving rehabilitation specialist would file a special application with the state. The states medical advisory committee would review each case individually. If the application is approved, the patient would have to demonstrate adequate driving skills on an extended state behind-the-wheel test by the state driver’s license bureau. Restrictions on type of driving and time of day could be considered in each case cases.

Please contact us if you have any questions:

The Low Vision Centers of Indiana
Richard L. Windsor, O.D., F.A.A.O., D.P.N.A.P.
Craig Allen Ford, O.D., F.A.A.O.
Laura K. Windsor, O.D., F.A.A.O.
Indianapolis (317) 844-0919
Fort Wayne (260) 432-0575
Hartford City (765) 348-2020
info@eyeassociates.com

From Hemianopsia.net, The Low Vision Centers of Indiana. Used with permission. www.hemianopsia.net.

Source: Hemianopsia and Driving: Are We Asking the Right Questions?

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[WEB SITE] Getting Neuro Patients Back On Their Feet

Published on January 17, 2017

Body weight support devices are available for use over a treadmill or overground. Patients who use these devices are often less fearful and more motivated knowing they are safely supported and not at risk of falling.

By Jessica Finnegan, PT, MPT, NCS

This is an exciting time in the world of neurologic physical therapy. Rehabilitation technologies are emerging and research is ongoing to determine the efficacy of these products. In the current healthcare environment, rehabilitation stays are becoming shorter and physical therapists (PTs) must find a way to prioritize which interventions will be most beneficial to their patients. This article discusses several rehabilitation technologies with the hope of helping PTs integrate them into their plans of care to improve mobility in patients recovering from stroke and other neurological disorders.

Convenience, Safety, and Early Mobility

Intensive, repetitive mobility-task training is recommended for all patients with impaired gait after stroke.1 In the past, mobilizing a patient with dense hemiparesis may have required two to three skilled therapists. This has obvious implications for staff efficiency and productivity. In addition, musculoskeletal injuries are commonly reported by healthcare providers and are often associated with manual patient handling.2 Workplace injuries can be a threat to the health and careers of PTs and should be avoided. Darragh and colleagues explored physical and occupational therapists’ experience with safe-patient-handling (SPH) equipment, such as ceiling lifts, floor lifts, and more. This equipment is becoming more widely available, allowing early mobilization of patients with fewer skilled staff members present and reduced risk of injury to the therapist. In this study, therapeutic uses of SPH equipment included transfer training, functional ambulation, and bed mobility.

Therapists also reported using SPH devices to address impaired attention, visual perception, and neglect. Overall, therapists who used SPH equipment “experienced increased options in therapy, accomplished more, and mobilized patients earlier in their recovery.” They also remarked that they needed to co-treat or solicit help from other professionals less frequently, which should improve productivity overall.3…

Recent technologies have entered the market that enable therapists to evaluate and train visual acuity and cognitive processing as part of rehab programs. These devices can target stroke, TBI, and neurocognitive conditions.

more —> Getting Neuro Patients Back On Their Feet – Physical Therapy Products

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[Abstract] Targeting interhemispheric inhibition with neuromodulation to enhance stroke rehabilitation. – Brain Stimulation

Highlights

  • This review focuses on interhemispheric inhibition and its role in the healthy and stroke lesioned brain.
  • Measurement method and movement phase should be considered when comparing studies associating interhemispheric inhibition with functional recovery.
  • Neuromodulation of interhemispheric inhibition to augment stroke recovery requires the targeting of specific neural circuitry. We discuss the effectiveness of current and novel neurostimulation techniques at targeting interhemispheric inhibition and enhancing stroke rehabilitation.

Abstract

Background/Objectives

Interhemispheric inhibition in the brain plays a dynamic role in the production of voluntary unimanual actions. In stroke, the interhemispheric imbalance model predicts the presence of asymmetry in interhemispheric inhibition, with excessive inhibition from the contralesional hemisphere limiting maximal recovery. Stimulation methods to reduce this asymmetry in the brain may be promising as a stroke therapy, however determining how to best measure and modulate interhemispheric inhibition and who is likely to benefit, remain important questions.

Methods

This review addresses current understanding of interhemispheric inhibition in the healthy and stroke lesioned brain. We present a review of studies that have measured interhemispheric inhibition using different paradigms in the clinic, as well as results from recent animal studies investigating stimulation methods to target abnormal inhibition after stroke.

Main findings/Discussion

The degree to which asymmetric interhemispheric inhibition impacts on stroke recovery is controversial, and we consider sources of variation between studies which may contribute to this debate. We suggest that interhemispheric inhibition is not static following stroke in terms of the movement phase in which it is aberrantly engaged. Instead it may be dynamically increased onto perilesional areas during early movement, thus impairing motor initiation. Hence, its effect on stroke recovery may differ between studies depending on the technique and movement phase of eliciting the measurement. Finally, we propose how modulating excitability in the brain through more specific targeting of neural elements underlying interhemispheric inhibition via stimulation type, location and intensity may raise the ceiling of recovery following stroke and enhance functional return.

Source: Targeting interhemispheric inhibition with neuromodulation to enhance stroke rehabilitation – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[BLOG POST] Amazon Echo: A Great Internet of Things (IoT) Device For People With Disabilities – Assistive Technology Blog

 

photo of amazon echo in a bookshelf
Off and on, you may have heard or read about Internet of Things (IoT). In the coming years, it is supposed to be a new phenomenon (it actually already is) that will make everything much easier and convenient for everyone. But what does it mean? What exactly is it, and how would it help people with disabilities?
Let’s start with the basics – What is Internet of Things? In the simplest of terms, it means that you, as a person, control everything around you (yes, everything!) through the internet. What that also means is that you don’t have to physically access an object to make it do something.
Let’s simplify this a little more further.
Let’s say you have a set of lights in your bedroom – one is a bulb in the ceiling and the other is a bedside lamp. When you go to bed, you physically reach the switch on the wall to turn off the ceiling light, and do something similar with the lamp as well (push a button on it to turn it off). In the morning, when you wake up, you push the button on the lamp again to turn it on, then stumble into the bathroom and look for the light switch, turn it on, and do your business. Everything after that (morning coffee, for example) requires a manual interaction with specific devices also.
With Internet of Things, everything is automated. Before going to bed, you either tell a “smart” device – “turn off all lights”, use an app on your phone, or make a gesture towards a smart device that it understands as a “turn off all lights” signal. When you wake up in the morning, you can have your bedroom lamp and bathroom lights turn on automatically at the same time. Half an hour later, coffee would be ready.
The basic idea here is that everything around you is connected to the Internet – from your lights in the house to your garage door to your car. With voice commands, mobile apps or gestures, you can set up a sequence in which everything you need readies itself without you having to manually interact with them.
Sticking with our example above – after you drink your morning coffee, you ask a device what the weather is like, what the news headlines are for today, and when the next bus is arriving at your nearest bus station. That device will answer all of your questions without you having to open up your other devices (computer, tablet, phone) to find those information.

Makes sense?

There are several companies that have made lots of amazing innovations in the IoT world. One of those innovations is Amazon’s Echo – a little, innocuous looking device that just sits in a corner, but does so many unbelievably powerful things. As a user you can just speak to It and ask it to perform certain actions, and it will do it for you in a jiffy.

What kind of things can it do though?

  1. To begin with, it can tell you the weather and traffic conditions. (“Alexa*, what’s the weather like?”, “Alexa what’s the traffic like?”)
  2. Read Kindle and Audible books to you, and play music for you. (“Alexa, play the Kindle book ‘Be Here Now’”, “Alexa, play ‘The Beatles’)
  3. Look up events and appointments on your calendar and let you know what your day looks like. (“Alexa, what does my day look like?”)
  4. Help you go to the movies by finding the nearest theater and local timings. (“Alexa, where is Deadpool playing?”)
  5. Find local businesses and restaurants. (“Alexa, what time does the nearby pharmacy close?”)
  6. Add items to your shopping list and also re-order previously ordered items from Amazon with just one voice command. (“Alexa, reorder laundry detergent”, “Alexa add coffee filters to my cart”)
  7. Helps you keep track of important tasks. (“Alexa, put ‘file taxes’ to my to-do list”)
  8. Control all lights and other devices around your house. (“Alexa, turn on light 1”, “Alexa, turn off the TV”)
  9. Control your thermostat. (“Alexa, set my bedroom temperature to 68”)
  10. Play games, order an Uber ride, order a pizza from Dominos!
  11. Lots and lots of other things!
*Amazon Echo is always listening for the keyword “Alexa”. If you start a sentence with Alexa, it knows that it is directed towards it (her?).

This video should give you a good understanding of how a person with disabilities can use Echo/Alexa at home.

Automation, in general, is a big victory for the regular consumer in terms of convenience. However, it brings a much bigger convenience and independence factor to people with disabilities, especially anyone who is blind, in a wheelchair, paraplegic, bed ridden because of a spinal cord injury, or doesn’t have good motor skills. It saves them a lot of time and energy by not making them interact with other devices that they may not have skills for or are unable to use them because of various disabilities. The only device they interact with is Echo, through voice, and it provides them with the results and information they are looking for instantly, and thus, saves them a lot of trouble. A person in a wheelchair doesn’t have to try to reach a light switch that’s in an awkward corner of a room, a person with not good motor skills doesn’t have to flip through pages or operate an e-reader to read their books, and a blind person doesn’t need to navigate a website on an electronic device to order a pizza anymore.
Automation through Internet of Things doesn’t only have to be at home. A device like Alexa can be installed by an employer at work as well so that employees with disabilities can be more comfortable in their work environments. A device like Echo is not expensive ($179), and it just makes the ability to provide accommodations an inherent part of the system, and not an afterthought.
This is just the beginning though. The kind of features Amazon keeps adding to Echo is mind boggling, and very exciting to say the least. Keep watching the IoT space to know about more innovations and automations for people with disabilities!

Source: Amazon Echo: A Great Internet of Things (IoT) Device For People With Disabilities – Assistive Technology Blog

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[WEB PAGE] ‘Knitted muscles’ provide power

January 25, 2017
'Knitted muscles' provide power

Conceptual model of a textile exoskeleton with the textile actuator (black) on an elastic elbow sleeve (white). Credit: Thor Balkhed/Linköping University

Researchers have coated normal fabric with an electroactive material, and in this way given it the ability to actuate in the same way as muscle fibres. The technology opens new opportunities to design “textile muscles” that could, for example, be incorporated into clothes, making it easier for people with disabilities to move. The study, which has been carried out by researchers at Linköping University and the University of Borås in Sweden, has been published in Science Advances.

Developments in robot technology and prostheses have been rapid, due to technological breakthroughs. For example, devices known as “” that act as an external skeleton and muscles have been developed to reinforce a person’s own mobility.

“Enormous and impressive advances have been made in the development of exoskeletons, which now enable people with disabilities to walk again. But the existing technology looks like rigid robotic suits. It is our dream to create exoskeletons that are similar to items of clothing, such as “running tights” that you can wear under your normal clothes. Such device could make it easier for older persons and those with impaired mobility to walk,” says Edwin Jager, associate professor at Division of Sensor and Actuator Systems, Linköping University.

Current exoskeletons are driven by motors or pressurised air and develop power in this way. In the new study, the researchers have instead used the advantages provided by lightweight and flexible fabrics, and developed what can be described as “textile muscles”. The researchers have used mass-producible fabric and coated it with an electroactive material. It is in this special coating that the force in the textile muscles arises. A low voltage applied to the fabric causes the electroactive material to change volume, causing the yarn or fibres to increase in length. The properties of the textile are controlled by its woven or knitted structure. Researchers can exploit this principle, depending on how the textile is to be used.

'Knitted muscles' provide power

A photograph of a knitted textile actuator (or textile muscle) including the electrical and mechanical contacts made of copper tape. Credit: Thor Balkhed/Linköping University

“If we weave the fabric, for example, we can design it to produce a high force. In this case, the extension of the fabric is the same as that of the individual threads. But what happens is that the force developed is much higher when the threads are connected in parallel in the weave. This is the same as in our muscles. Alternatively, we can use an extremely stretchable knitted structure in order to increase the effective extension,” says Nils-Krister Persson, associate professor in the Smart Textiles Initiative at the Swedish School of Textiles, University of Borås.

The researchers show in the article that the textile muscles can be used in a simple robot device to lift a small weight. They demonstrate that the technology enables new ways to design and manufacture devices known as “actuators”, which – like motors and biological muscles – can exert a force.

'Knitted muscles' provide power

From left to right: A single yarn coated with the electroactive polymer (polypyrrole); a knitted textile actuator (or textile muscle) including the electrical and mechanical contacts made of copper tape; and a piece of knitwear coated with the electroactive polymer (polypyrrole). Credit: Thor Balkhed/Linköping University

“Our approach may make it possible in the long term to manufacture actuators in a simple way and hopefully at a reasonable cost by using already existing textile production technologies. What’s more interesting, however, is that it may open completely new applications in the future, such as integrating textile muscles into items of clothing,” says Edwin Jager.

'Knitted muscles' provide power

Photo of the knitted textile actuator mounted in the force measurement setup. On the top the actuator is mounted to the lever arm of the force sensor using a small electrically insulated hook. On the bottom it is both electrically and mechanically connected in a beaker that contains the liquid electrolyte. A second, auxiliary electrode (the piece of gold coated plastic) is also inserted in the container to close the electrical circuit. Credit: Thor Balkhed/Linköping University

Explore further: ‘Space cloth’ to revolutionise textiles industry

More information: “Knitting and weaving artificial muscles,” Science Advances, DOI: 10.1126/sciadv.1600327 , http://advances.sciencemag.org/content/3/1/e1600327

Source: ‘Knitted muscles’ provide power

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[WEB SITE] How to PERMANENTLY Treat Post Stroke Spasticity

The Complete Guide to Treating Post Stroke Spasticity – for Good!

Post stroke spasticity is the most common post stroke side effect, and it’s likely that you’ve never heard the whole truth about it.

The causes of spasticity are somewhat talked about, but no one really discusses the root cause of the problem. Today we’re sharing the most valuable way to fix this frustrating problem, starting with the basics, the part that everyone talks about, and moving on to the lesser-known stuff later.

Spasticity as Brain-Muscle Miscommunication

You’ve probably heard spasticity explained in relation to your muscles.

Spasticity causes your muscles to become tightened, so it’s natural to focus on your muscles as what needs to be fixed. But spasticity is actually caused by miscommunication between your brain and your muscles.

Normally your muscles are in constant communication with your brain about how much tension they’re feeling, and the brain has to constantly monitor this tension to prevent tearing. Your brain continuously sends out messages telling your muscles when to contract and relax.

When a stroke damages part of the brain responsible for muscle control, this communication is thrown off. The damaged part of your brain no longer receives the messages that your muscles are trying to send, and as a result, your brain no longer tells them when to contract or relax.

That’s the cause of spasticity from the brain-muscle perspective.

However, there’s a second layer to spasticity that no one talks about. Spasticity is also caused by miscommunication from your spinal cord.

The OTHER Cause of Spasticity

While your muscles are always in communication with your brain, they’re also in communication with your spinal cord.

Usually the spinal cord takes the messages from your muscles and sends them up to the brain. But since the brain is no longer reading those messages, your affected muscles have no one to talk to.

So the spinal cord takes over.

But the spinal cord doesn’t know how to properly operate your muscles. It really only has one goal: to prevent your muscles from tearing. In order to do that, your spinal cord sends signals to keep your muscles in a constant state of contraction, which is what causes spasticity.

Your spinal cord only has the best intentions – to prevent your muscles from tearing – but it’s frustrating because now your muscles are painfully stiff.

Let’s look at some temporary and permanent treatment options to fix this issue and alleviate your spasticity.

How to Temporarily Treat Spasticity

There are temporary ways to treat spasticity, which includes locally administered or orally taken drugs.

Locally administered drugs are injected into the affected muscles and help reduce pain, increase movement, and curb potential bone and joint problems.

Orally taken drugs offer the same benefits, but they are not site-specific and will affect all the muscles in your body.

The problem with taking drugs to treat spasticity is that it’s a short-term solution that only treats the symptom, not the underlying cause.

So how can you treat the underlying cause?

With the help of your good ol’ friend neuroplasticity.

How to Permanently Reduce Spasticity

Neuroplasticity is your long-term, permanent solution to overcoming spasticity.

When a stroke damages part of the brain responsible for motor function, it decreases the number of brain cells dedicated to moving your affected limbs. Neuroplasticity comes into play by rewiring your brain and dedicating more brain cells to controlling your affected limbs.

In order for this rewiring to occur, you have to repeat your rehab exercises over and over. The more you repeat the movement, the better the spasticity will subside and movement will improve.

It’s like paving new roads. The more you reinforce those new roads, the stronger they’ll become.

Putting in hard work is essential.

4 Ways to Reap More Benefit from Hard Work

If spasticity is causing you pain, then using temporary solutions in the meantime can help alleviate the barriers keeping you from your rehab exercises; making more room for hard work.

There are 4 ways to maximize your benefit from hard work:

There’s one thing these methods all have in common: Repetition.

No matter which option you choose, be sure to create an at-home rehabilitation regimen that utilizes a high number of repetitions.

You’ll get better faster this way because it’s the only way to retrain your brain to relax your spastic muscles – permanently.

If You Think You’re Paralyzed – You Probably Aren’t

Believing that your movement is too limited to regain any more movement is a limiting belief; and limiting beliefs will limit your recovery.

The truth is that if you think you’re paralyzed, you’re probably not. Not 100%.

To explain how, we need to define what ‘paralysis’ really means.

There are 2 types of true paralysis:

  • Flaccid paralysis where muscles do not contract at all
  • Spastic paralysis where muscles are so tight with spasticity that you can’t move them

These forms of paralysis are very rare, and most survivors fall somewhere on the spectrum of ‘hemiparesis,’ which is weakness – not paralysis – in the affected side of the body.

And tiny amounts of movement are a sign that more movement can be regained.

Spasticity as a Surprising Sign of Hope

Although spasticity is unwanted and often painful, it’s also a surprising sign of hope.

The appearance of spasticity (as laid out in the Brunnstrom stages of stroke recovery) means that you’re not flaccid and there’s room to improve.

All you have to do is start taking tiny steps, and slowly more movement will sneak in and spasticity will get pushed out.

But remember, it requires hard work and dedication. To get started, we recommend reading up on different methods for motivation to help propel your efforts.

Recommended reading:

Source: How to PERMANENTLY Treat Post Stroke Spasticity – Flint Rehab

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[VIDEO] Botox Injections for Stroke & Spasticity Recovery – YouTube

Δημοσιεύτηκε στις 12 Μαΐ 2012

Sarah Abrusley discusses her recovery from a 2007 stroke and how Botox injections have relaxed the muscle tone and spasticity she was suffering in her left arm and hand. She is under the care of Dr. Andrea Toomer of Culicchia Neurological Clinic in New Orleans.

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[VIDEO] Fighting Spasticity After Stroke – YouTube

In this stroke recovery exercise Lora places her affected hand on top of the ball. She then spread her fingers as far apart from each other as she can and holds them in place with her unaffected hand. She then rocks the ball back and forth.

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