[Poster] Feasibility of Online Training and Certification for the Fugl-Meyer Motor Assessment in Stroke Recovery Trials

Abstract

Introduction: Standardized measurement of clinical outcomes across sites and over time is critical to clinical trials. Barriers to outcome measure training include availability of standardized materials and time to train, plus wide geographic distribution of trial personnel. To address these, an online training and certification program based on NIHSS testing was developed and implemented for the Fugl Meyer Motor Assessment (FMMA) in support of multisite stroke recovery trials.

Methods: This program includes Fugl Meyer Arm (FMA) and Leg (FML) components, runs on a web host, and is based on a valid, reliable approach to FMMA testing known to decrease variance in scoring (See et al, NNR, 2013;27:732-741). The website hosts training courses, reference manuals, video patient cases for formal certification testing plus 3 rounds of recertification; each round has 2 separate patients. A passing score of 90% is required. After each course, feedback is given.

Results: This program has served as the primary training, certification, and recertification mechanism for 4 multisite recovery trials, including 1 NIH-funded US trial and 3 industry-sponsored international trials. Three trials certify on both FMA and FML, and 1 on FMA only, as primary endpoint. Evaluators are recertified every 4-6 months. The 299 clinicians from 5 countries registered include PT/OT (n=136), MD (n=37), and RN/NP/PA (n=15). For FMA training, 299 persons have registered and 197 completed. For the first round of FMA certification, 267 have registered and 171 passed (mean 1.89 attempts to pass). For the second FMA (first recertification), 78 registered and 65 passed. The passing rate increased with successive rounds of recertification. Similar numbers have been achieved for FML training, certification, and recertification.

Conclusions: The FMMA has established value for capturing treatment-related motor gains in stroke recovery trials. The current online training program is efficient and effective for training, certifying, and recertifying examiners in arm and leg FMMA. Clinical trial assessors training with this program can be expected to provide more accurate and less variable FMMA scores, which increases statistical power, reduces sample sizes, and reduces the cost of clinical trials.

 

via Abstract TP141: Feasibility of Online Training and Certification for the Fugl-Meyer Motor Assessment in Stroke Recovery Trials | Stroke

[Abstract] Virtual Activities of Daily Living for Recovery of Upper Extremity Motor Function

Abstract

A study was conducted to investigate the effectiveness of virtual activities of daily living (ADL) practice using the SaeboVR software system for the recovery of upper extremity (UE) motor function following stroke. The system employs Kinect sensor-based tracking to translate human UE motion into the anatomical pose of the arm of the patient’s avatar within a virtual environment, creating a virtual presence within a simulated task space. Patients gain mastery of 12 different integrated activities while traversing a metaphorical ‘road to recovery’ that includes thematically linked levels and therapist-selected difficulty settings. Clinical trials were conducted under the study named Virtual Occupational Therapy Application. A total of 15 chronic phase stroke survivors completed a protocol involving three sessions per week over eight weeks, during which they engaged in repetitive task practice through performance of the virtual ADLs. Results show a clinically important improvement and statistically significant difference in Fugl-Meyer UE assessment scores in the study population of chronic stroke survivors over the eight-week interventional period compared with a non-interventional control period of equivalent duration. Statistically significant and clinically important improvements are also found in the wolf motor function test scores. These results provide new evidence for the use of virtual ADL practice as a tool for UE therapy for stroke patients. Limitations of the study include non-blinded assessments and the possibility of selection and/or attrition bias. © 2017 IEEE.

 

via Scopus preview – Scopus – Document details

[Abstract] An intelligent, adaptive, performance-sensitive, and virtual reality-based gaming platform for the upper limb.

Abstract

Stroke is a leading cause of adult disability, characterized by a spectrum of muscle weakness and movement abnormalities related to the upper limb. About 80% of individuals who had a stroke suffer from upper limb dysfunction. Conventional rehabilitation aims to improve one’s ability to use paralyzed limbs through repetitive exercise under one-on-one supervision by physiotherapists. This poses difficulty given the limited availability of healthcare resources and the high cost of availing specialized services at healthcare centers, particularly in developing countries like India. Thus, the design of cost-effective, home-based, and technology-assisted individualized rehabilitation platform that can deliver real-time feedback on one’s skill progress is critical. This paper describes the design of a novel, multimodal, virtual reality (VR)-based, and performance-sensitive exercise platform that can intelligently adapt its task presentation to one’s performance. Here, we aim to address unilateral shoulder abduction and adduction that are essential for the performance of daily living activities. We designed an experimental study in which six individuals who had chronic stroke (post-stroke period: >6 months) participated. While they interacted with our VR-based tasks, we recorded their physiological signals in a synchronized manner. Preliminary results indicate the potential of our VR-based, adaptive individualized system in the performance of individuals who had a stroke suffering from upper limb movement disorders.

© 2018 John Wiley & Sons, Ltd.

 

via Scopus preview – Scopus – Document details

[VIDEO] Functional electrical stimulation after stroke – YouTube

STIWELL Neurorehabilitation

Published on Jan 25, 2018

After a stroke, patients may no longer be able to correctly perform simple everyday movements, such as drinking from a glass.

Drinking is still realized as a task, but the impulse sent to the brain is not sufficient to trigger the proper movement.

This process can be practiced with functional electrical stimulation to improve motion sequences on a long-term basis.

The EMG function of the STIWELL electrostimulator measures and enhances the patient’s motion impulse to enable successful movement. Multi-channel electrical impulses support motion control.

For more than 20 years STIWELL has leased and sold electrostimulation devices to provide comprehensive therapy after stroke and other neurological diseases. For more information please visit http://www.stiwell.com/

This video is for demonstration purposes only. The products, applications and performance characteristics are subject to approval by the responsible national authorities. Not all components may be available in your country or provided by MED-EL for sale in your country.

© MED-EL, technical realization: https://zeitraum.com/

 

[BLOG POST] Sleep Disorders After Brain Injury, PTSD, TBI

Why Do So Many Survivors Have Sleep Disorders After Brain Injury?

January 2018,  Written by Bill Herrin

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January’s Brain Injury Journey Bulletin dives into the new year with a topic that often keeps people up at night…sleep disorders after TBI.

Sleep. It can be elusive, and one of the most frustrating things to accomplish after brain injury – especially on a consistent basis. Quite often, sleep disorders can take hold after brain injury – and cause everything from anxiousness to feeling depressed, tired, irritable, and more. In this issue of the Brain Injury Journey Bulletin, we’re going to take a look at all the things that sleep can affect, and some ways to conquer a sleep disorder after TBI.

Tossing and Turning

When your quality of life is being affected by lack of sleep, the desperation of wanting to rest can actually hinder you from getting the rest you need. Here are some changes in sleep patterns after TBI that are quite common:

• difficulty falling asleep easily
• trouble staying asleep throughout the night
• waking up very early in the morning and not falling back to sleep
• falling asleep and awakening far later than desired
• purposely staying up late at night to get things done

Examples are:

• You get into bed around 10 but it takes you several hours to fall asleep.
• You wake up frequently during the night for no major reason.
• You wake up at 4 in the morning and cannot fall back to sleep.
• You’re up late every night working on the computer and your partner keeps asking
  you to come to bed.

Sleep Disorders and Other Factors

There are lots of different sleep disorders, and they can involve many different parts of the brain. Here are some of the more well-known sleep disorders that people encounter: Insomnia, extreme drowsiness, altered sleep patterns and Narcolepsy. Other disorders that can directly contribute to lack of sleep are Restless Leg Syndrome, teeth grinding or clenching, involuntary movements of your arms/legs during sleep, sleepwalking, sleep apnea, etc. Other factors that can deprive you from sleep are pain, alcohol, caffeine and nicotine, depression…and naps. A poorly timed nap (late in the day) obviously can end up backfiring on you later that night! It’s best to limit the length of naps so they help you get through the day, but don’t keep you up at night.

When PTSD is involved, especially in military veterans, sleep disorders can disturb sleep to the point of a person dreading bedtime, and efforts to quiet the symptoms with drugs or alcohol can make symptoms worse in the long run. Hyper-alertness, flashbacks, or nightmares can play a big part in keeping PTSD survivors up at night.

Research has found that sleep disorders are 3 times more common in persons with TBI than the general population, that about 60% of TBI survivors have ongoing problems with sleeping, that women are more affected than men…and that aging increases the likelihood of sleep problems.

This group has been researching how people sleep, and they have collected some great information about how drug addiction and recovery can affect a person’s ability to have healthy, restorative sleep….along with addressing other sleep disorders. You can read the full guide at this link.

Better sleep?

Sleep, when achieved regularly, brings a bevy of positive side-effects, and is an essential component of mental and physical well-being. It can affect healing of the brain and body, improve short-term memory and attention, improvement of your mood, and it can even reduce physical pain. The main thing that sleep obviously provides is that you feel rested and more alert!

How You Sleep Also Matters

Being uncomfortable can affect your sleep more than you realize, too. Here’s a link to an article on WebMD.com that covers different sleep positions, and how they can help (or hinder) sleep, or even cause pain in your back, neck, etc.  Here’s the link.

Talk It Over With Your Doctor

There are plenty of over-the-counter and off-the-shelf medications specifically made to help you “catch some ZZZZZ’s” – but it’s very important that persons with brain injury talk to their doctor about the side effects of sleep medications before using any of them.

Brain injury presents a variety of issues that can cause stress, and the stress can easily parlay itself into loss of sleep. If loss of sleep is wearing you down, or slowing your recovery after TBI, you should speak with a physician right away. Once you seek medical advice, the doctor can help you discover the causes and effects of your sleep issues, and discuss all possibilities of easing the loss of sleep. From sleep labs to prescription medications, to discussing techniques for easing your mind before bedtime, your doctor will hopefully help you resolve the sleep deprivation to some degree.

Suggested Reading

The person you are with little or no sleep, versus the one you are when well rested can be like the difference in…well, like night and day! Tips for managing your sleep schedule, and how to improve it, are available in this easy-to-read tip card – available on our website. It’s titled “Sleep after brain injury”, and if you go to this link, you can get a free tip card and catalog.  Here’s the link. for the catalog & tip card. Here’s more info on the SLEEP tip card.

New Year, New Sleep Habits?

With a new year started, you can reference any issues imaginable that relate to PTSD, TBI, ABI, brain injury, concussion, and more, on Lash & Associates’ blog page. Specifically relating to the new year, realistic resolutions after TBI, here is a blog article by Donna O’Donnell Figurski that talks all about it. Here’s the link.

Knowing that stress and anxiety (after TBI) can take its toll, this blog post by Marilyn Lash and Taryn Stejskal, discusses managing stress, and the symptoms of stress that become evident when they’re taking their toll on your health and well-being. Here’s the link.

Blog Posts Galore On A Wide Range of TBI Issues

Feel free to keyword search our entire collection of blog posts, many written by well-known experts, clinicians in the field of brain injury, and also people who have survived brain injury, had family members that have a TBI, and much more. It’s a treasure trove of information that is available for FREE, 24/7/365. It’s all for you at this link!

Resolution of sleeping issues is a “2018 Resolution” for the new year that many have added to their lists to  achieve. We hope that you have a great new year, and that you rest assured…and sleep well!

 

 

 

 

via Sleep Disorders After Brain Injury, PTSD, TBI

[BLOG POST] Tryptophan in Mood, Anxiety, and Depression

 

Deficiency of monoamines, such as dopamine, epinephrine, and serotonin, is the most widely accepted theory explaining mood disorders. Among these neuromediators, serotonin deficiency is considered as most significant in relation to anxiety and depression. This theory has been proven by the effectiveness of drugs that help to increase monoamines levels in the brain, although research in this direction has been hampered by the limitations of present-day technology in measuring the levels of specific monoamines and their properties. However, studies do indicate that their deficiency plays a role in individuals prone to mood swings.

Tryptophan as precursor for serotonin

Tryptophan is one of the essential amino acids. It can’t be produced by our body and has to come through food products rich in proteins. It is required for both anabolic processes and production of various hormones. Tryptophan is a chemical precursor for the synthesis of the neurotransmitter serotonin. This means that the amount of serotonin produced in our body is dependent on the dietary intake of tryptophan. Since serotonin is related to mood regulation, it is entirely possible that tryptophan deficits may have a negative effect on our mood state. On the other hand, its supplementation may be helpful in disorders like anxiety or depression. Multiple investigations seem to support the idea that decreased levels of tryptophan lead to a reduction in serotonin and changes in mood. Some studies have indicated that higher intake of tryptophan may improve social interactions by improving mood and decreasing aggression and dominant behavior.

Serotonin in mood and cognition

Serotonin is important for both mood regulation and regulation of cognitive functions like learning and memory. The effect of monoamine inhibitors called serotonin reuptake inhibitors in various disorders of mood supports this theory. However, it is important to keep in mind that antidepressants are only partially effective in treating mood disorders since monoamine deficits are just one of the factors influencing mood. Most of the serotonin in our body is produced outside the brain, indicating that this compound has a much broader role in our normal physiology. It is possible that many functions of serotonin are still not understood.

Tryptophan depletion and mood regulation

To understand the role of serotonin, and more specifically tryptophan, many tryptophan-depletion studies have been done in recent times. In one simple crossover study, 25 healthy adults were studied for mood changes like anxiety and depression after consuming either a high tryptophan diet or a low tryptophan diet for four days. Tryptophan consumption seems to affect mood even in such a short interval. The study showed that those on a high tryptophan diet had much better mood as compared to those on a low tryptophan diet, although the negative effects of a low tryptophan diet were less pronounced. If such a quick and straightforward analysis can show the difference, it is entirely possible that long-term low tryptophan consumption or depletion may have much graver consequences for mental health.

Tryptophan and gut-brain axis

When we talk about the gut-brain axis we are not just discussing the digestive role of the gut and its effect on overall health, something that has been well known for many years. Our digestive system is also involved in neuro-hormonal signaling, through which it can have an impact on brain functioning. Recently, the influence of gut health on the brain has been the subject of many studies and for good reason. Our gut has more nerve cells than our spine, and it produces many hormones that have various implications for health. Further, it is now well understood that the neural relationship between the gut and brain is dual-sided, and there are more nerve fibers sending information from the gut to the brain rather than from the brain to the gut. Thus, due to the effect of nerves, hormones, and other neurologically active compounds, the gut plays a prominent role in mental wellbeing. Even small changes in the gut could directly affect our behavior. Gut microbiota and their relationship to mood have also recently received lots of attention.

When it comes to tryptophan, the digestive system is not solely involved in its absorption or metabolism. Now it is well-established that serotonin is mostly produced in the gut rather than in the brain, further strengthening the theory of gut-brain interrelation. This theory explains the mood alterations in irritable bowel syndrome (IBS). Further, the development of IBS has been shown to be connected to tryptophan depletion.

The studies show that tryptophan depletion, due to its relationship with serotonin, is undoubtedly one of the most essential elements to consider when analyzing altered mood and cognition. Low serotonin could generally cause a state of lowered mood, impaired cognition, poor working memory, and lower reasoning. Conversely, high tryptophan supplementation could have a positive effect on mood, memory, energy level, and emotional processing.

Low dietary consumption of tryptophan could be one of the elements leading to chronic conditions like depression and anxiety. Bowel conditions like IBS that disturb tryptophan metabolism and alter serotonin levels may also modify our behavior and feelings.

The search for effective therapeutic approaches to the treatment of mood disorders, anxiety, and depression has gained lots of attention in the last few decades. Understanding the role of tryptophan may open up new possibilities for managing mood and cognition problems. It is quite possible that a high tryptophan diet may not only help to prevent mood disorders but also increase the effectiveness of existing drug therapies.

References

Delgado, P. L. (2000) Depression: the case for a monoamine deficiency. The Journal of Clinical Psychiatry, 61 Suppl 6, 7–11. PMID: 10775018

Jenkins, T. A., Nguyen, J. C. D., Polglaze, K. E., & Bertrand, P. P. (2016) Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. Nutrients, 8(1). doi: 10.3390/nu8010056

Lindseth, G., Helland, B., & Caspers, J. (2015). The Effects of Dietary Tryptophan on Affective Disorders. Archives of Psychiatric Nursing, 29(2), 102–107. doi: 10.1016/j.apnu.2014.11.008

Young, S. N., & Leyton, M. (2002) The role of serotonin in human mood and social interaction. Insight from altered tryptophan levels. Pharmacology, Biochemistry, and Behavior, 71(4), 857–865. PMID: 11888576

Young, S. N., Smith, S. E., Pihl, R. O., & Ervin, F. R. (1985) Tryptophan depletion causes a rapid lowering of mood in normal males. Psychopharmacology, 87(2), 173–177. doi: 10.1007/BF00431803

Image via freeGraphicToday/Pixabay.

via Tryptophan in Mood, Anxiety, and Depression | Brain Blogger

 

[BLOG POST] Brain training devised by Brighton researcher cuts epileptic seizures

Posted On 19 Jan 2018 at 4:33 pm by : Frank le Duc

Brain training devised by a Brighton clinical researcher can cut the number and frequency of epileptic seizures in patients who have not responded to drug treatment.

Details of the groundbreaking research have been published in The Lancet and Cell Press journal Ebiomedicine.

One in 100 people suffer with epilepsy – 50 million people worldwide – with about 30 per cent of them apparently unable to benefit from drugs to manage the condition.

About half of those taking part in clinical trials reported that the technique reduced seizures by 50 per cent or more.

It was invented by Yoko Nagai, Wellcome Trust Research Fellow at the Brighton and Sussex Medical School, run jointly by Brighton University and Sussex University.

The technique is seen as an alternative to medication by teaching patients to train their brains to be more alert.

Previous mental techniques have been aimed at relaxing the brain to reduce seizures but Dr Nagai’s research found the opposite was true – that training patients to increase their levels of alertness helped them to become better at calming their brain and reducing seizures.

Volunteers used an animated computer programme that responds to a person’s level of alertness.

They were shown how to increase their alertness by learning to move a computer-generated animated figure towards a desired goal.

The method relies on “lie detector” technology, with sensors attached to patients’ fingers.

Patients focus on the computer figure and the sensors pick up brain and body activity including emotional distress and alteration in the sweat glands and these, in turn, signal the figure to move.

The technique teaches patients to acquire a sense of control by concentrating on the screen activity.

In a previous randomised controlled trial with 18 patients, 60 per cent of drug resistant patients demonstrated more than 50 per cent seizure reduction after a month of therapy.

And two who went on to keep a record for three years after their “training” continued to have a greatly reduced number of seizures with learnt techniques.

Yoko Nagai

 

For the current trials, 40 patients with drug-resistant temporal lobe epilepsy, aged 18 to 70, were recruited for a controlled trial from three screening centres.

Some 45 per cent of patients demonstrated a reduction in seizures of 50 per cent or more.

Dr Nagai said: “Our clinical study provides evidence for autonomic biofeedback therapy as an effective and potent behavioural intervention for patients with drug-resistant epilepsy.

“This approach is non-pharmacological, non-invasive and seemingly side-effect free.”

She now hopes further collaborations may lead to a simple online digital computer programme being developed for patients to use anytime and anywhere in the world.

via Brighton and Hove News » Brain training devised by Brighton researcher cuts epileptic seizures

[BLOG POST] Caregiver Fatigue for TBI is an ongoing challenge

February, 2018

By Bill Herrin

Click Here to sign up to receive a BULLETIN monthly!!!

 

Caring for someone with a brain injury, especially a family member,  is an honorable duty. It’s really well beyond that, and when it’s 24 hours a day, 7 days a week – and for many, without a day off – caregiver fatigue can be all-consuming. This month’s Brain Injury Journey Bulletin delves into the incredibly underrated tasks that caregivers face every day, and how they can deal with compassion fatigue, irritability, and yes…just plain “burnout.”

Knowing a person well before their brain injury, and seeing their behavior change can both frustrate and confuse a caregiver. These behavior changes may reflect the survivor’s struggles with cognitive issues, impaired motor skills, loss of self, memory issues, and other stresses. While a caregiver may be the survivor’s  rock and fortress to get through each day, it’s not easy for the caregiver and  can weigh heavily. The caregiver’s frustration can build, and lashing out in the slightest ways can take the whole process in reverse, instead of forward.

A great blog article by April Groff, PhD, lists some wonderful prevention strategies for caregivers. They’re well-structured, effective ways to keep from getting frustrated more than necessary with daily caregiving. Here’s a great checklist that I’ve excerpted from that blog article:

Prevention strategies to reduce caregiver fatigue and frustrations

• Establish a structured environment and daily routine. They are essential to reduce behavioral problems related to memory. Having a written daily schedule that is similar from day to day can make it easier for your loved one to remember what is expected and what to do next.
• Keep household objects in the same designated places. Use the same route to walk to a specific location.
• Keep distractions to a minimum and focus on one task at a time.
• Use a memory aid system specific to the person’s needs. This may require writing down key information on a calendar, in a memory notebook, or in a smart phone. It may involve using visual reminders, alarms, or labels.
• Have the person wear an ID bracelet with brain injury status, address, and emergency phone numbers.

Tips for responding to the person with a brain injury

• If the person repeatedly asks a question, provide an answer. Repeat yourself. It’s easy to get frustrated or to feel like the person isn’t listening to you, but don’t take it personally. Remember that it is the brain injury causing the behavior, not the person.
• Stay calm and be patient. Offer reassurance with a calm voice. Don’t argue or try to use logic to convince the person to behave differently.
• Focus on the emotion, not the behavior. Rather than reacting to repetition, try to think about how the person is feeling and respond to the feeling.
• Use memory aids. Refer to calendars, notebooks, smart phones, visual reminders, or other memory aids familiar to the person.
• Engage the person in an activity. Provide structure and try to engage the person in a pleasant activity.
• If the behavior isn’t harmful, try not to worry about it. Find ways to accept and work with it rather than trying to stop it or change it.

A person with a brain injury carries a heavy load – and everyone handles their own situation differently. When a survivor hit’s the point of “overload”, they can become upset, they may lash out and say things that they don’t really mean. All these things can wear down the caregiver’s energy and patience. Every time this happens, don’t forget that the person may not recall “acting out” prior to this. This “reset” technique will limit any negative response to them – no matter how hard it is to do at the time. Keep in mind that it’s how they’re feeling at the time. Frustration for the caregiver is going to happen, but just maintaining a good level of empathy will help things go better, and in a more positive direction.

There are plenty more incredible insights on the aforementioned blog by Dr. April Groff, and the link to it is here. Print it out, and you’ll have a truly incredible checklist of useful pointers, encouraging tips, and helpful information for a caregiver to refer to.

Caregivers get angry too

Taking the discussion a step further, caregiver fatigue and anger can result from slow progress after a brain injury, coupled with financial stress, competing demands of other family members, and

anxiety about the future. Hearing questions being asked again and again, dealing with angry outbursts by the survivor, and coping with frustration over daily routines, etc. – all can pile up into a “mental mountain” for the caregiver that is coupled with physical exhaustion.  In Janet Cromer’s blog post “Take the Danger Out of TBI Caregiver Anger”, she offers sage advice on dealing with cognition and memory, changes in relationships, and handling a survivor’s anger and irritability.

Ms. Cromer succinctly notes the process in this simple sentence: “Many TBI caregivers describe this cycle of anger, guilt about feeling angry, then anger about feeling guilty.” She draws from her own personal experiences as a caregiver for her husband, and as a mental health professional. For plentiful, and invaluable advice – you can read her full blog article here.

To close, Lash & Associates, a leading publisher of products for the Brain Injury Community, offers tons of blog articles on our award-winning website. Keyword search your topic of choice (relating to PTSD, concussion, brain injury, etc.) and see all that is available! Our product line is broad and extensive, as well. You can search our products at www.lapublishing.com

We hope you have some great “takeaway” from this month’s Brain Injury Journey Bulletin, and we hope that you share it with anyone that can benefit from a free email subscription to receive it monthly. Sign up HERE!

Until next time,

The Lash & Associates Team

via caregiver fatigue for TBI is an ongoing challenge

[WEB SITE] Augmented and virtual reality will involve human senses in verifying the operations of information systems — ScienceDaily

Many new applications aim to make information systems and machines identify their users and take their individual needs and emotions into account. VTT Technical Research Centre of Finland Ltd studied how ordinary consumers could reliably verify the operation of systems by using human senses.

In the future, machines and AI systems will have a deeper understanding of the actions of their human users. Even now, AI is able to generate an image of what a human is watching on the screen just by recording brain activity or deduce the emotions of people from microexpressions taken from their faces.

In the Human Verifiable Computing project, VTT used augmented and virtual reality to develop solutions for building trust between people and systems and facilitating the verification of information security. This is a vital aspect of the digital future, in which interaction between people and computers will be an effortless part of everyday life. “Augmented and virtual reality technologies let us make fuller use of our senses and enable the constant mutual evaluation of reliability between humans and machines,” says Senior Scientist Kimmo Halunen of VTT.

Making cryptographically verifiable computing available to human users was a key part of the project.

The project demonstrated functionalities involving computing verified with human senses. For example, augmented reality was utilized to distribute single-use passwords, which could then be used through voice recognition. Augmented reality was also utilized to give multisensory feedback by showing visual instructions to a maintenance worker who turns a valve and receives an error message if the valve is operated incorrectly. The message can be implemented as an interactive image and also presented through audio on the user’s smart glasses. In addition, haptic feedback can be provided by making the user’s smart watch or other mobile device vibrate.

The results of the project indicate that the basic technology required for the verification of computing with the human senses is already available. The combination of augmented reality and safety information will also enable new services. Current cryptographic methods and protocols are nearly always applied to communication between machines. Including the user in the interaction will nevertheless require more research and system and application development, as well as more study of human behaviour.

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Story Source:

Materials provided by VTT Technical Research Centre of Finland. Note: Content may be edited for style and length.

 

via Augmented and virtual reality will involve human senses in verifying the operations of information systems — ScienceDaily

[WEB SITE] Treating Levetiracetam-Induced Behavioral Effects With Vitamin B6

Data showed that 11.8% of levetiracetam-treated patients experienced behavioral side effects.

Daily pyridoxine (vitamin B6) was found to be an effective treatment for the behavioral adverse effects seen with the antiepileptic drug levetiracetam, according to a poster presented at the AES Annual Meeting 2017.

Treatment with levetiracetam (Keppra; UCB) has been shown to cause non-psychotic behavioral effects (eg, aggression, anger, emotional lability, anger, depression, anxiety) in clinical studies (13% in levetiracetam-treated patients vs 6% in placebo-treated). Currently, there is a lack of data regarding the treatment of behavioral effects of levetiracetam, which represents a key cause of treatment discontinuation.

For the retrospective study, Creighton University School of Medicine researchers evaluated whether pyridoxine supplementation could benefit patients who are experiencing behavioral adverse effects due to levetiracetam. The team reviewed electronic medical records of all patients in the Creighton University Epilepsy Center Clinic (2011–2015) for those taking levetiracetam. Forty-five of the 380 total patients receiving levetiracetam (median dose 1000mg daily; highest dose 4000mg daily) were initiated on pyridoxine 100mg daily for symptom control.

The data showed 11.8% of levetiracetam-treated patients experienced behavioral side effects with agitation, insomnia, and irritability being the most commonly observed. These behavioral changes were typically seen within the first month of starting levetiracetam therapy. Nearly all of the patients who received pyridoxine (42/45; 93.3%) remained on levetiracetam therapy as they saw significant improvement in their behavioral symptoms.

RELATED ARTICLES

• Mental Health Comorbidities Common in Epilepsy
• Foramen Ovale EEG Identifies Epileptogenic Zone in Mesial Temporal Lobe Epilepsy
• Significant Drug-Drug Interactions With Cannabidiol and Antiepileptics

“This benefit is seen across the entire range of levetiracetam dosing,” lead author Kalyan Sajja noted. Supplementation with pyridoxine 100mg daily enabled continued treatment with levetiracetam in these patients. The authors added that a large multicenter, prospective, randomized-controlled trial can further validate this clinical benefit.

Reference

Sajja K, Sankaraneni R, Galla K, Singh SP. Role of Pyridoxine (Vitamin B6) in the Treatment of Levetiracetam Induced Behavioral Effects in Epilepsy Patients. Presented at: AES annual meeting in Washington, DC. Abstract 1.308.

via Treating Levetiracetam-Induced Behavioral Effects With Vitamin B6