Archive for December, 2017

[BLOG POST] 5 Things Every TBI Survivor Wants You to Understand

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March is National Brain Injury Awareness Month, and as promised, I am writing a series of blogs to help educate others and bring awareness to traumatic brain injuries (TBI).

1. Our brains no longer work the same. 
We have cognitive deficiencies that don’t make sense, even to us. Some of us struggle to find the right word, while others can’t remember what they ate for breakfast. People who don’t understand, including some close to us, get annoyed with us and think we’re being “flaky” or not paying attention. Which couldn’t be further from the truth, we have to try even harder to pay attention to things because we know we have deficiencies.

Martha Gibbs from Richmond, VA, suffered a TBI in May of 2013 after the car she was a passenger in hit a tree at 50 mph. She sums up her “new brain” with these words:

Almost 2 years post-accident, I still suffer short-term memory loss and language/speech problems. I have learned to write everything down immediately or else it is more than likely that information is gone and cannot be retrieved. My brain sometimes does not allow my mouth to speak the words that I am trying to get out.

2. We suffer a great deal of fatigue.
We may seem “lazy” to those who don’t understand, but the reality is that our brains need a LOT more sleep than normal, healthy brains. We also have crazy sleep patterns, sometimes sleeping only three hours each night (those hours between 1 and 5 a.m. are very lonely when you’re wide awake) and at other times sleeping up to 14 hours each night (these nights are usually after exerting a lot of physical or mental energy).

Every single thing we do, whether physical or mental, takes a toll on our brain. The more we use it, the more it needs to rest. If we go out to a crowded restaurant with a lot of noise and stimulation, we may simply get overloaded and need to go home and rest. Even reading or watching tv causes our brains to fatigue.

Toni P from Alexandria, VA, has sustained multiple TBI’s from three auto accidents, her most recent one being in 2014. She sums up fatigue perfectly:

I love doing things others do, however my body does not appreciate the strain and causes me to ‘pay the price,’ which is something that others don’t see.  I like to describe that my cognitive/physical energy is like a change jar. Everything I do costs a little something out of the jar.  If I keep taking money out of the jar, without depositing anything back into the jar, eventually I run out of energy. I just don’t know when this will happen.  Sometimes it’s from an activity that seemed very simple, but was more work then I intended. For me, like others with TBIs, I’m not always aware of it until after I’ve done too much.

3. We live with fear and anxiety. 
Many of us live in a constant state of fear of hurting ourselves again. For myself personally, I have a fear of falling on the ice, and of hitting my head in general. I know I suffered a really hard blow to my head, and I am not sure exactly how much it can endure if I were to injure it again. I am deeply afraid that if it were to take another blow, I may not recover (ie, death) or I may find myself completely disabled. I am fortunate to have a great understanding of the Law of Attraction and am trying my hardest to change my fears into postive thoughts with the help of a therapist.

Others have a daily struggle of even trying to get out of bed in the morning. They are terrified of what might happen next to them. These are legitimate fears that many TBI survivors live with. For many, it manifests into anxiety. Some have such profound anxiety that they can hardly leave their home.

Jason Donarski-Wichlacz from Duluth, MN, received a TBI in December of 2014 after being kicked in the head by a patient in a behavioral health facility. He speaks of his struggles with anxiety:

I never had anxiety before, but now I have panic attacks everyday. Sometimes about my future and will I get better, will my wife leave me, am I still a good father. Other times it is because matching socks is overwhelming or someone ate the last peanut butter cup.

I startle and jump at almost everything. I can send my wife a text when she is in the room. I just sent the text, I know her phone is going to chime… Still I jump every time it chimes.

Grocery stores are terrifying. All the colors, the stimulation, and words everywhere. I get overwhelmed and can’t remember where anything is or what I came for.

4. We deal with chronic pain.
Many of us sustained multiple injuries in our accidents. Once the broken bones are healed, and the bruises and scars have faded, we still deal with a lot of chronic pain. For myself, I suffered a considerable amount of neck and chest damage. This pain is sometimes so bad that I am not able to get comfortable in bed to fall asleep. Others have constant migraines from hitting their head. For most of us, a change in weather wreaks all sort of havoc on our bodies.

Lynnika Butler, of Eureka, CA, fell on to concrete while having a seizure in 2011, fracturing her skull and resulting in a TBI. She speaks about her chronic migraine headaches (which are all too common for TBI survivors)

I never had migraines until I sustained a head injury. Now I have one, or sometimes a cluster of two or three, every few weeks. They also crop up when I am stressed or sleep deprived. Sometimes medication works like magic, but other times I have to wait out the pain. When the migraine is over, I am usually exhausted and spacey for a day or two.

5. We often feel isolated and alone.
Because of all the issues I stated above, we sometimes have a hard time leaving the house. Recently I attended a get together of friends at a restaurant. There were TVs all over the room, all on different channels. The lights were dim and there was a lot of buzz from all of the talking. I had a very hard time concentrating on what anyone at our table was saying, and the constantly changing lights on the TVs were just too much for me to bear. It was sensory stimulation overload. I lasted about two hours before I had to go home and collapse into bed. My friends don’t see that part. They don’t understand what it’s like. This is what causes many of us to feel so isolated and alone. The “invisible” aspect of what we deal with on a daily basis is a lonely struggle.

Kirsten Selberg from San Francisco, CA, fell while ice skating just over a year ago and sustained a TBI. She speaks to the feelings of depression and isolation so perfectly:

Even though my TBI was a ‘mild’ one, I found myself dealing with a depression that was two-fold. I was not only depressed because of my new mental and physical limitations, but also because many of my symptoms forced me to spend long periods of time self-isolating from the things — like social interactions — that would trigger problems for me. With TBI it is very easy to get mentally and emotionally turned inward, which is a very lonely place to be.

Also, check out my other blogs on the Huffington Post:
“Life With a Traumatic Brain Injury”
“Life With a TBI: March is National Brain Injury Awareness Month”

I invite you to join my TBI Tribe on Facebook if you are a survivor, or loved one of a survivor.

via 5 Things Every TBI Survivor Wants You to Understand | HuffPost

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[Abstract] Effect of postural insoles on gait pattern in individuals with hemiparesis: A randomized controlled clinical trial.

Abstract

Introduction

Recovering the ability to walk is an important goal of physical therapy for patients who have survived cerebrovascular accident (stroke). Orthotics can provide a reduction in plantar flexion of the ankle, leading to greater stability in the stance phase of the gait cycle. Postural insoles can be used to reorganize the tone of muscle chains, which exerts an influence on postural control through correction reflexes. The aim of the present study was to perform kinematic and spatiotemporal analyses of gait in stroke survivors with hemiparesis during postural insole usage.

Material and Methods

Twenty stroke victims were randomly divided into two groups: 12 in the experimental group, who used insoles with corrective elements specifically designed for equinovarus foot, and eight in the control group, who used placebo insoles with no corrective elements. Both groups were also submitted to conventional physical therapy. The subjects were analyzed immediately following insole placement and after three months of insole usage. The SMART-D 140® system (BTS Engineering) with eight cameras sensitive to infrared light and the 32-channel SMART-D INTEGRATED WORKSTATION® were used for the three-dimensional gait evaluation.

Results

Significant improvements were found in kinematic range of movement in the ankle and knee as well as gains in ankle dorsiflexion and knee flexion in the experimental group in comparison to the control group after three months of using the insoles.

Conclusion

Postural insoles offer significant benefits to stroke survivors regarding the kinematics of gait, as evidenced by gains in ankle dorsiflexion and knee flexion after three months of usage in combination with conventional physical therapy.

Keywords:

via Effect of postural insoles on gait pattern in individuals with hemiparesis: A randomized controlled clinical trial – Journal of Bodywork and Movement Therapies

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[WEB SITE] ‘Motivating alternative’: Virtual reality therapy just as effective as regular therapy after stroke.

Image: Photographee.eu via Shutterstock

USING VIRTUAL REALITY therapy to improve arm and hand movement after a stroke is equally as effective as regular therapy, new research has found.

“Virtual reality training may be a motivating alternative for people to use as a supplement to their standard therapy after a stroke,” study author Irish Brunner of Aarhus University said.

The study, published in Neurology, involved 120 people with an average age of 62 who had suffered a stroke on average about a month before the study started.

Each participant had a mild to severe muscle weakness about a month before the study started. All participants had mild to severe muscle weakness or impairment in their wrists, hands or upper arms.

They all received four to five hour-long training sessions per week for four weeks. They also had their harm and hand functions tested at the beginning of the study after the training ended and again three months after the study had begun.

Half of the participants had received standard physical and occupational therapy. Meanwhile, the other had virtual reality training that was designed for rehabilitation and could be adapted to the person’s abilities.

Those doing the virtual reality training used a screen and gloves with sensors to play several games that incorporated arm, hand and finger movements.

“Both groups had substantial improvement in their functioning, but there was no difference between the two groups in the results,” Brunner said.

These results suggest that either type of training could be used, depending on what the patient prefers.

Brunner noted that the virtual reality system was not an immersive experience.

“We can only speculate whether using virtual reality goggles or other techniques to create a more immersive experience would increase the effect of the training.”

via ‘Motivating alternative’: Virtual reality therapy just as effective as regular therapy after stroke

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[WEB SITE] Walk 4,000 steps every day to boost brain function

Recent research led by the University of California, Los Angeles shows that taking a short walk each day can help to keep the brain healthy, supporting the overall resilience of cognitive functioning.
seniors walking in the park

Could a walk in the park help to maintain cognitive health in old age?

As we grow older, memory problems can begin to set in. These could be a natural part of aging and a minor annoyance, but in some cases, the issues may indicate mild cognitive impairment and could even develop into dementia.

Regardless of how mild or severe these memory problems may be, they are definitely distressing and can affect an individual’s quality of life.

New research from the Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles suggests that there is a relatively easy way of keeping your brain in top shape as you grow older: take a moderately long walk every day.

This could boost your attention, the efficiency with which you process information, and other cognitive skills, say first study author Prabha Siddarth and colleagues.

The research findings were recently published the Journal of Alzheimer’s Disease.

Cortical thickness to assess cognitive health

Siddarth and team initially recruited 29 adults aged 60 and over, of which 26 completed the study over a 2-year period. The participants were split into two distinct groups:

  • a low physical activity group, comprising people who walked 4,000 or fewer steps each day
  • a high physical activity group, made up of people who walked more than 4,000 steps per day

All the participants reported a degree of memory complaints at baseline, but none of them had a dementia diagnosis.

In order to explore the potential effect of physical activity on cognitive ability, the researchers used MRI to determine the volume and thickness of the hippocampus, which is a brain region associated with memory formation and storage, and spatial orientation.

Previous research suggested that the size and volume of this brain region can tell us something about cognitive health. For instance, a higher hippocampal volume has been shown to indicate more effective memory consolidation.

“Few studies have looked at how physical activity affects the thickness of brain structures,” says Siddarth.

“Brain thickness,” she notes, “a more sensitive measure than volume, can track subtle changes in the brain earlier than volume and can independently predict cognition, so this is an important question.”

Walk more every day for a resilient brain

In addition to the MRI scans, the participants also underwent a set of neuropsychological tests, to consolidate the assessment of their cognitive capacity.

It was found that those in the high physical activity group — who walked more than 4,000 steps (approximately 3 kilometers) each day — had thicker hippocampi, as well as thicker associated brain regions, when compared with that of the those falling under the low physical activity category.

The highly active group was also found to have better attention, speedier information processing abilities, and more efficient executive function, which includes working memory. Working memory is the resource that we tap into on a daily basis when we need to make spontaneous decisions.

However, Siddarth and colleagues reported no significant differences between the high activity and low activity groups when it came to memory recall.

The next step from here, the researchers suggest, should be to undertake a longitudinal analysis in order to test the relationship between physical activity and cognitive ability over time.

They also note the need to better understand the mechanisms behind cognitive decline in relation to hippocampal atrophy.

via Walk 4,000 steps every day to boost brain function

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[WEB SITE] Pregnant Women with Epilepsy Who Take Folic Acid Reduce the Risk of Having an Autistic Child.

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BY SARAH OWENS

Pregnant women taking antiepileptic drugs (AEDs) who supplemented their diets with folic acid had a reduced risk of having a child with autistic traits, according to a study published online on December 26 in JAMA Neurology.

Folic Acid’s Importance

Folic acid supplements are generally recommended to all pregnant women to reduce the risk of birth complications, such as spina bifida, as well as neurodevelopmental complications.

Supplementation may be especially important for pregnant women who take AEDs, which treat epilepsy and seizures, since anti-seizure drugs are known to interfere with folate absorption and metabolism.

Additionally, research has shown that children born to mothers who took AEDs during pregnancy have an increased risk of developing autistic traits, including repetitive behaviors and impaired social skills and communication.

Studying Mothers with Epilepsy

To find out if folic supplementation would decrease the risk of having a child with autistic traits for women taking AEDs during pregnancy, researchers at several universities in Norway assessed data on participants in the Norwegian Mother and Child Cohort study, a long-running study of the health of pregnant women and their children in Norway. Participants had an ultrasonographic examination between June 1999 and December 2008 and provided information on their use of AEDs and folic acid supplementation during pregnancy as well as follow-up information on the health of their children.

A total of 104,946 children between the ages of 18 and 36 months who were born between March 2016 and June 2017, were included. As part of the study, the mothers answered questions about their children’s health using a test that measures autistic traits. The mothers were asked questions such as, “Does your child enjoy being bounced on your knee?” and “Does your child take interest in other children?”

The researchers then compared the mothers’ information on AED use and folic acid supplementation with their answers on the test to look for associations.

A Clear Connection

The researchers discovered that women who took AEDs during pregnancy and also took folic acid supplements were significantly less likely to have a child with autistic traits than pregnant women who took AEDs but did not supplement with folic acid. In particular, they found that higher folic acid levels between weeks 17 and 19 of pregnancy were associated with a reduced risk of autistic traits.

The findings, the study authors conclude, suggest that all women of childbearing age who take AEDs should take folic acid supplementation to reduce the risk of autistic traits in their children.

via Neurology Now

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[ARTICLE] Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review – Full Text

Abstract

Question

What are the attitudes, barriers and enablers to physical activity perceived by pregnant women?

Design

In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework.

Participants

Pregnant women.

Intervention

Not applicable.

Outcome measures

Attitudes and perceived barriers and enablers to physical activity during pregnancy.

Results

Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity.

Conclusion

Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women’s positive attitudes into increased physical activity participation.

Introduction

Physical activity has substantial benefits for women with uncomplicated pregnancies, minimal risks, and is recommended in pregnancy guidelines.1, 2, 3 The benefits of physical activity during pregnancy include improved physical fitness,3, 4, 5 reduced risk of excessive weight gain,6 reduced risk of pre-eclampsia and pre-term birth,7reduced low back pain,8, 9 improved sleep,10 reduced anxiety and depressive symptoms,11, 12 and improved health perception13 and self-reported body image.14

Physical activity is also important for pregnant women with comorbidities and complications such as obesity1 or gestational diabetes mellitus (GDM).15, 16, 17 Physical activity assists with weight control and reduces the risk of GDM in obese pregnant women.1 In women diagnosed with GDM (a common pregnancy-related complication occurring in 3.5 to 12% of pregnancies),15, 16 physical activity is beneficial as an adjunctive intervention in the management of glycaemic control.15, 17, 18, 19, 20 Managing glycaemic control is critical for reducing adverse effects associated with poorly controlled GDM.21 Consequently, aerobic exercise performed at moderate intensity for 30 minutes on most days of the week is recommended for healthy pregnant women,1, 3 those with GDM15, 22,23 and those who are overweight or obese.24

Despite well-documented health benefits,1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 24, 25, 26, 27 60 to 80% of pregnant women28, 29, 30, 31 – including those who are overweight or obese31 – and more than 60% of women with GDM32 do not participate in physical activity as recommended. Pregnant women from backgrounds other than Caucasian are also less likely to engage in physical activity.29 However, to improve pregnant women’s participation in physical activity (ie, leisure time physical activities or structured exercise programs), we need to understand their attitudes to it, the reasons why they do not engage in physical activity, and enablers that could be harnessed to design effective physical activity interventions or programs that facilitate behaviour change and thereby improve their participation in physical activity during pregnancy.

The inclusion of behaviour change techniques into physical activity interventions has been reported as helpful in improving physical activity levels during pregnancy.33 Behaviour change techniques such as goal setting, planning and education to shape knowledge appear most effective when delivered with face-to-face feedback about goal achievement.33 However, to facilitate uptake of these effective physical activity interventions, clinicians need to know which barriers, enablers and attitudes are common among pregnant women, so they can effectively target their education and evidence-based behaviour change strategies. A systematic review of barriers, enablers and attitudes of pregnant women to physical activity would provide valuable information to enable clinicians to effect a positive behaviour change of increased physical activity in this group.

Identification of women’s attitudes and perceptions of barriers and enablers to physical activity in pregnancy could be informed by quantitative or qualitative research approaches. A review that collates data from studies using either method would benefit from the advantages of each: improving generalisability and providing deeper insights into pregnant women’s beliefs and perceptions about physical activity during pregnancy. Inclusion of qualitative findings may assist in better understanding the factors that can influence women’s attitudes and perceptions. Such deeper understanding would provide valuable insight that clinicians can use to plan strategies to encourage pregnant women – in particular at-risk groups of women such as those with GDM – to participate in physical activity. It would also inform the design of realistic and acceptable interventions to be tested in an effectiveness study. No systematic review has collated quantitative data or provided a meta-summary of attitudes and perceptions of barriers and enablers to physical activity in pregnant women.

Therefore, the research question for this review was:

What are the attitudes, barriers and enablers to physical activity perceived by pregnant women, including women diagnosed with gestational diabetes mellitus?

Continue —> Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review – Journal of Physiotherapy

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[ARTICLE] Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial – Full Text

Abstract

Question

What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program?

Design

A randomised, controlled trial with blinded outcome assessment at baseline and at 3, 6, 9 and 12 months. The economic evaluation took the form of a trial-based, comparative, incremental cost-utility analysis undertaken from a societal perspective with a 12-month time horizon.

Participants

People with chronic health conditions who had completed a 6-week exercise program at a community health service.

Interventions

One group of participants received a gym-based exercise program and health coaching for 12 months. The other group received a home-based exercise program and health coaching for 12 months with telephone follow-up for the first 10 weeks.

Outcome measures

Healthcare costs were collected from government databases and participant self-report, productivity costs from self-report, and health utility was measured using the European Quality of Life Instrument (EQ-5D-3L).

Results

Of the 105 participants included in this trial, 100 provided sufficient cost and utility measurements to enable inclusion in the economic analyses. Gym-based follow-up would cost an additional AUD491,572 from a societal perspective to gain 1 quality-adjusted life year or 1 year gained in perfect health compared with the home-based approach. There was considerable uncertainty in this finding, in that there was a 37% probability that the home-based approach was both less costly and more effective than the gym-based approach.

Conclusion

The gym-based approach was more costly than the home-based maintenance intervention with telephone support. The uncertainty of these findings suggests that if either intervention is already established in a community setting, then the other intervention is unlikely to replace it efficiently.

Introduction

Chronic conditions that are related to physical inactivity, such as coronary heart disease, type II diabetes and stroke, are estimated to result in direct healthcare costs of over AUD377 million per year in Australia.1 ;  2 Implementing strategies to increase physical activity in adults with chronic health conditions may be an effective way of reducing the economic impact in Australia. Short-term (ie, 4 to 6 week) supervised interventions, such as cardiac and pulmonary phase II rehabilitation programs, have been shown to be effective in improving quality of life and reducing morbidity and healthcare costs.3 ;  4However, there is evidence to suggest that once the program is completed, adherence to exercise declines along with the health benefits obtained.5 Hence, there is a need to provide interventions to promote long-term exercise adherence after the completion of a short-term exercise program.

A recent review of this field identified two commonly investigated approaches to improve ongoing exercise adherence for adults with chronic health conditions: home-based exercise programs with telephone follow-up, and gym-based exercise programs.6 That review and meta-analysis found no difference in exercise adherence rates between these interventions. Furthermore, it identified no economic evaluations examining the comparative efficiency of the two approaches.

There is an ongoing need to identify efficient means of promoting adherence to exercise in the long term, in order to improve the quality of life of adults with chronic health conditions. The aim of the current study was to examine the economic efficiency of home-based maintenance with telephone follow-up compared with gym-based maintenance exercise amongst adults with a variety of chronic conditions who had completed a short-term supervised exercise program led by a health professional.

Therefore, the study question for this economic analysis of that randomised trial was:

What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program?

[…]

Continue —> Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial

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[Commentary] Family-led rehabilitation after stroke may not improve patient outcomes compared to usual care. [commentary]

Commentary

Training families to assist with therapy interventions seems sensible. Families are present more regularly than health professionals and are often keen to help. It is not unusual for physiotherapists to ask family members to assist with therapy programs for patients of all ages with stroke or other diagnoses, particularly when access to physiotherapy is limited. Small studies have been conducted in this area1 and in other areas of allied health practice;2 however, there is no clear conclusion as to whether this practice is safe and/or effective.

The study by the ATTEND Collaborative Group is the first large trial to investigate the effectiveness of family-led rehabilitation. It was well-designed, with high methodological quality (PEDro score 8/10). Importantly, the trial found that training families to conduct a rehabilitation program including physical interventions did not increase caregiver burden, and was safe. However, it showed no improvement in patient outcomes. Outcomes ranging from death and disability to quality of life showed no difference between intervention and control groups.

Shall we as physiotherapists therefore stop engaging families in physiotherapy? It is important to understand that the focus of this study was on task shifting, in a setting where usual care interventions were very limited. It highlights that the role of trained physiotherapists in stroke management is not easily replaced.

Involving families in physiotherapy is an emerging area of research. Future research will need to acknowledge the complexities of family engagement and consider whether families are being trained to fulfil a caring role or a therapy role, to replace therapists or augment physiotherapy interventions.

References

    • 1
    • J. Vloothuis, et al.
    • Cochrane Database Syst Rev, 12 (2016) CD011058
    • 2
    • K. Lawler, et al.
    • Arch Phys Med Rehabil, 94 (2013), pp. 1139–1160

via Family-led rehabilitation after stroke may not improve patient outcomes compared to usual care [commentary]

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[WEB SITE] World Health Organisation Says Cannabidiol Could Have Therapeutic Value For Seizures.

Although the World Health Organisation (WHO) has not gone so far as to endorse the use of medicinal marijuana in the treatment of certain conditions and diseases, they have recently stated that “Recent evidence from animal and human studies shows that a compound derived from marijuana (cannabidiol) could have some therapeutic value for seizures due to epilepsy and related conditions” and that it “is not likely to be abused or create dependence as for other cannabinoids”

The decision was not an endorsement of medical marijuana. Instead the global body’s Expert Committee on Drug Dependence specifically examined the potential risks and benefits cannabidiol (CBD), a compound that is found in cannabis plant.

Read the full article here: http://www.independent.co.uk/news/world/americas/us-politics/marijuana-compound-cannabis-harmless-world-health-organisation-seizures-epilepsy-a8109001.html

via Cannabidiol could have therapeutic value | Epilepsy Research UK

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[Editorial] Advances in Neural Engineering for Rehabilitation – Behavioural Neurology

Neurorehabilitation has been identified as a grand challenge for the coming decades, mainly due to the fast-growing population with neurological disorders (e.g., stroke, Alzheimer’s, and Parkinson’s). Efficient, quantitative, and automated rehabilitation services are in urgent need to release the increasing demands for long-term medical treatments and healthcare and to compensate the lack of manpower in rehabilitation professionals. Neural engineering is an active research area, where engineering technologies, such as robots, imaging, biosignal processing, and sensors, have contributed to diagnosis, treatment, and long-term evaluation in rehabilitation processes. Advances in neural engineering techniques, from the fundamental research in laboratories to clinical trials, will definitely promote the automated and personalized rehabilitation in the future. There are ten articles collected in this special issue, featuring the cutting-edge representatives in the area of neural engineering.

A robot has been an important assistant to a human therapist in physical rehabilitation. The review articles, “Hand Rehabilitation Robotics on Poststroke Motor Recovery” by Z. Yue et al. and “Robotics in Lower-Limb Rehabilitation after Stroke” by X. Zhang et al., pointed out the therapeutic difficulties encountered in the traditional poststroke rehabilitation, that is, the recovery in distal joints and the restoration on walking independency. The papers summarized the latest developments in the robotic design and discussed the possible solutions to improve the performance of the current robots. In the article “Effects of Robot-Assisted Training for the Unaffected Arm in Patients with Hemiparetic Cerebral Palsy: A Proof-of-Concept Pilot Study” by A. Picelli et al., the positive rehabilitation effectiveness by practicing the unaffected upper limb with the assistance of robot has been validated, and the results demonstrated the improvements in hand functions and action planning ability in the recruited subjects. Rehabilitation robot was also applied in the study “The Effect of Dopaminergic Medication on Joint Kinematics during Haptic Movements in Individuals with Parkinson’s Disease” by K. Li et al. The haptic sensitivity in individuals with Parkinson’s disease, who received dopamine replacement therapy, was quantitatively evaluated in a robot-assisted haptic exploration.

Neural signal processing is a technology to understand the language talking in the nervous system. The neural signal of the brain detected by electroencephalography (EEG) was adopted as a biofeedback in the treatment for schizophrenia, as presented in “An Exploratory Study of Intensive Neurofeedback Training for Schizophrenia” by W. Nan et al. The study demonstrated the effectiveness of a short but intensive neurofeedback treatment for the patients with difficulty in long-time training and provided new insight into the treatment of schizophrenia. The neural signal of the brain was also investigated by electrocorticography (ECoG) in persons with epilepsy in the study “Gesture Decoding Using ECoG Signals from Human Sensorimotor Cortex: A Pilot Study” by Y. Li et al. The ECoG signals were used in a brain-machine interfacing (BMI) system to recognize different hand gestures performed by the subjects with an online accuracy above 80%. In the study “Prior Knowledge of Target Direction and Intended Movement Selection Improves Indirect Reaching Movement Decoding” by H. Li et al., the neural signals with higher resolutions than EEG and ECoG were captured by implanted microarrays at the cortical level in monkeys, and the neural signals were applied in the prediction of hand trajectories.

Quantitative evaluation plays an important role in diagnosis and long-term follow-up for rehabilitation. The imaging techniques of functional magnetic resonance imaging (fMRI) have been employed in the studies “The Difference of Neural Networks between Bimanual Antiphase and In-Phase Upper Limb Movements: A Preliminary Functional Magnetic Resonance Imaging Study” by Q. Lin et al. and “Cerebral Reorganization in Subacute Stroke Survivors after Virtual Reality-Based Training: A Preliminary Study” by X. Xiao et al. In Q. Lin et al.’s work, the effects of different bimanual practices in the upper limbs on the intra- and interregional connectivity in the brain were investigated in unimpaired subjects, and the results revealed the behavioral modulation on the cerebellar-cerebral functional connectivity. In X. Xiao et al.’s work, fMRI imaging was applied in the evaluation on the poststroke rehabilitation program by virtual reality-enhanced treadmill training. The neural reconstruction in the primary sensorimotor cortex after the training could be determined with the imaging quantification. In the study “Characterizing Patients with Unilateral Vestibular Hypofunction Using Kinematic Variability and Local Dynamic Stability during Treadmill Walking” by P. Liu et al., the asymmetry and instability during the gait of the patients were evaluated by three-dimensional motion analysis. The severity of vestibular functional asymmetry could be quantified by the parameters of the motion analysis on the lower limbs, which could be complementary to the traditional assessments.

We hope that this special issue of Behavioral Neurology will help to promote further developments in neural engineering and neurorehabilitation. In addition to reducing suffering and improving the quality of life, neurorehabilitation when combined with novel engineering methods has the potential to advance our knowledge about the mechanisms of the nervous system.

Acknowledgments

We would like to express our deepest gratitude to many reviewers, whose professional comments guaranteed the high quality of the selected papers. In addition, we also would like to express our appreciation to the editorial board members and publishing office of the journal for their help and support throughout the preparation of this special issue.

Xiaoling Hu
Ting Zhao
Jun Yao
Yu Kuang
Yuan Yang

via Advances in Neural Engineering for Rehabilitation

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