Archive for February, 2018

[ARTICLE] Using the Oxford Cognitive Screen to Detect Cognitive Impairment in Stroke Patients: A Comparison with the Mini-Mental State Examination – Full Text

Background: The Oxford Cognitive Screen (OCS) was recently developed with the aim of describing the cognitive deficits after stroke. The scale consists of 10 tasks encompassing five cognitive domains: attention and executive function, language, memory, number processing, and praxis. OCS was devised to be inclusive and un-confounded by aphasia and neglect. As such, it may have a greater potential to be informative on stroke cognitive deficits of widely used instruments, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment, which were originally devised for demented patients.

Objective: The present study compared the OCS with the MMSE with regards to their ability to detect cognitive impairments post-stroke. We further aimed to examine performance on the OCS as a function of subtypes of cerebral infarction and clinical severity.

Methods: 325 first stroke patients were consecutively enrolled in the study over a 9-month period. The OCS and MMSE, as well as the Bamford classification and NIHSS, were given according to standard procedures.

Results: About a third of patients (35.3%) had a performance lower than the cutoff (<22) on the MMSE, whereas 91.6% were impaired in at least one OCS domain, indicating higher incidences of impairment for the OCS. More than 80% of patients showed an impairment in two or more cognitive domains of the OCS. Using the MMSE as a standard of clinical practice, the comparative sensitivity of OCS was 100%. Out of the 208 patients with normal MMSE performance 180 showed impaired performance in at least one domain of the OCS. The discrepancy between OCS and MMSE was particularly strong for patients with milder strokes. As for subtypes of cerebral infarction, fewer patients demonstrated widespread impairments in the OCS in the Posterior Circulation Infarcts category than in the other categories.

Conclusion: Overall, the results showed a much higher incidence of cognitive impairment with the OCS than with the MMSE and demonstrated no false negatives for OCS vs MMSE. It is concluded that OCS is a sensitive screen tool for cognitive deficits after stroke. In particular, the OCS detects high incidences of stroke-specific cognitive impairments, not detected by the MMSE, demonstrating the importance of cognitive profiling.

Introduction

Stroke is the second most common cause of death and the third most common source of disability (12). Its prevalence and incidence increases with age representing the leading cause of disability in the elderly (2). Patients with stroke have cognitive deficits in a very high proportion of cases [e.g., Ref. (1)], although variables estimates are reported. The differences are likely due to variability in sample characteristics, assessment methods, definitions of impairment, and time interval since stroke onset (1). As cognitive assessment is time consuming, physicians often use smart tools to assess cognitive impairment in stroke survivors that need little time but are often of limited use to highlight cognitive dysfunction, typically yielding relatively low-prevalence rates, below 25% (34). On the opposite, more detailed neuropsychological assessments of domain-specific cognitive impairments consume more time but are better at detecting cognitive impairment, highlighting higher occurrences, ranging from 35 to 92% (58). Language, spatial attention, memory, praxis, executive function, and speed of processing are the main impaired cognitive domains (5). Moreover, psychiatric comorbidities such as depression and delirium often occur after a stroke (9). Cognitive deficits interfere with rehabilitation and represent a negative prognostic factor (1011), impacting on activities of daily living, quality of life, and return to work (12).

Stroke guidelines recommend the importance of early cognitive diagnosis in order to plan tailored rehabilitation programs (13). Tools, such as the Mini-Mental State Examination [MMSE; (14)] and the Montreal Cognitive Assessment [MoCA; (15)], are widely used as a practical solution to briefly assess cognition post-stroke. However, these instruments were devised for evaluation of patients with dementia and only provide a “domain-general” cognitive score with a single cutoff for impairment. The present study describes the use of a newly devised instrument, the Oxford Cognitive Screen (OCS), against one of these two reference tools, namely the MMSE; in a parallel study, we examined the effectiveness of the OCS against the MoCA (16).

Interest in using the MMSE as a comparison chiefly stems from its wide use; indeed, it is one of the most widely tests used in clinical practice. Early reviews emphasized the reliability and construct validity of the MMSE to capture moderate-to-severe cognitive impairment (17). However, the limits of the MMSE are also well-known particularly in the assessment of stroke patients (1819). In spite of this, the MMSE is still one of the instruments which is most widely used nowadays in clinical settings to detect global cognitive impairment in patients with stroke (2030). In particular, it is used as a diagnostic index in the stroke units to plan the rehabilitation interventions as well as in the identification of cognitive profiles after non-dementia cerebro-vascular events (21293133).

The key problem in using the MMSE to assess stroke sequelae is that it does not explicitly assess common post-stroke domain-specific impairments such as neglect, executive function, apraxia, and aphasia. Indeed, performance on the MMSE can be confounded by co-occurring difficulties in these domains. For example, a patient with expressive aphasia will maximally score 4 points (out of a maximum 30) as the large majority of tasks require spoken language. This would lead to a potential misclassification of patients as “dementia” where there is a specific language impairment. Similarly, specific cognitive impairments may be “missed” in patients with stroke. This lack of specificity contrasts the indications of several clinical guidelines which emphasize the need to assess performance across different domains of cognition after stroke [e.g., Ref. (234)].

The OCS was recently developed with the specific aim of describing the cognitive deficits after stroke (35); OCS was devised to be inclusive and un-confounded by aphasia and neglect. It can be administered within 15 min, can be delivered at the bedside, is easy to administer and score, can be used in relatively acute phase (after 3 days from onset) and provides a “snapshot” of a patient’s cognitive profile useful to define the rehabilitative program. The possibility to have separate cutoff for each of the tasks used allows obtaining a cognitive pinpointing strengths and weaknesses of individual stroke patients.

The scale consists of 10 tasks encompassing five cognitive domains: attention and executive function, language, memory, number processing, and praxis. Furthermore, it includes a brief evaluation of visual field defects. Administration is simple and brief (ca. 15 min) making it also suitable for immobilized patients. Demeyere et al. (16) provided initial data on a sample of stroke patients indicating the ability of the scale to detect differentiated profiles across the various domains and also reported a greater sensitivity of OCS over MoCA.

In order to assess whether this new instrument provides a sensitive and practical first line assessment supporting wider adoption, the present study aimed to compare the OCS with the MMSE in detecting cognitive symptoms after stroke, thereby providing further data on the sensitivity and specificity of the OCS in the identification of cognitive deficits in a relatively large sample of first stroke patients. We also examined OCS performance as a function of subtypes of cerebral infarction [based on the Bamford classification; (36)] and clinical severity [based on the National Institutes of Health Stroke Scale, NIHSS; (37)]. […]

 

Continue —-> Frontiers | Using the Oxford Cognitive Screen to Detect Cognitive Impairment in Stroke Patients: A Comparison with the Mini-Mental State Examination | Neurology

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[ARTICLE] Neural predictors of gait stability when walking freely in the real-world – Full Text

Abstract

Background

Gait impairments during real-world locomotion are common in neurological diseases. However, very little is currently known about the neural correlates of walking in the real world and on which regions of the brain are involved in regulating gait stability and performance. As a first step to understanding how neural control of gait may be impaired in neurological conditions such as Parkinson’s disease, we investigated how regional brain activation might predict walking performance in the urban environment and whilst engaging with secondary tasks in healthy subjects.

Methods

We recorded gait characteristics including trunk acceleration and brain activation in 14 healthy young subjects whilst they walked around the university campus freely (single task), while conversing with the experimenter and while texting with their smartphone. Neural spectral power density (PSD) was evaluated in three brain regions of interest, namely the pre-frontal cortex (PFC) and bilateral posterior parietal cortex (right/left PPC). We hypothesized that specific regional neural activation would predict trunk acceleration data obtained during the different walking conditions.

Results

Vertical trunk acceleration was predicted by gait velocity and left PPC theta (4–7 Hz) band PSD in single-task walking (R-squared = 0.725, p = 0.001) and by gait velocity and left PPC alpha (8–12 Hz) band PSD in walking while conversing (R-squared = 0.727, p = 0.001). Medio-lateral trunk acceleration was predicted by left PPC beta (15–25 Hz) band PSD when walking while texting (R-squared = 0.434, p = 0.010).

Conclusions

We suggest that the left PPC may be involved in the processes of sensorimotor integration and gait control during walking in real-world conditions. Frequency-specific coding was operative in different dual tasks and may be developed as biomarkers of gait deficits in neurological conditions during performance of these types of, now commonly undertaken, dual tasks.

Background

Recent developments in mobile technologies enable the design of experiments describing behavioural and neural responses of subjects performing commonly observed tasks in real-world scenarios outside of the experimental lab environment [1]. Such tasks may include artistic performance such as dancing and music playing [2], dealing with stressful situations [3] and evaluating changes in the levels of “excitement”, “engagement” and “frustration” when walking within different city areas [45]. An interesting aspect of these novel experimental approaches is the possibility to correlate brain activity and natural behaviour, in both healthy and neurologically impaired populations [1]. For example, recent evidence has suggested that the pre-frontal cortex (PFC) is involved in multitasking behaviours [678] and that the posterior parietal cortex (PPC) is engaged in motor adaptation during walking in health [91011]. These regions have also been shown to be involved in different attentional [12] and executive function networks [13]. Gait initiation failure (GIF) and freezing of gait (FoG) episodes in freely walking Parkinson’s disease (PD) patients have been correlated with increased neural activity and connectivity between different cortical regions such as occipital, parietal and frontal regions [1415]. Clinically, difficulties in free walking are observed to increase with the severity of PD due to damage in the cortical-striatal locomotor network [16]. Ambulatory abilities of PD patients are impaired by muscular hypertonia and hypokinesia, which induce asymmetries and reduce speed, as well as FoG [17]. PD patients have less control of their posture when standing, walking and compensating for an external perturbation and this may lead to an increased magnitude of postural sway [18]. Specifically, the magnitude of medio-lateral sway was shown to be highly sensitive to postural impairments during both standing and over-ground free walking and this progressed with the severity of PD [1920].

In ths study, we used a smartphone to measure the acceleration root mean square index (RMS) as an indication of the magnitude of movements or sway at the pelvis in any of the three movement directions (i.e., vertical, antero-posterior and medio-lateral) [18212223]. Previous investigations have shown that RMS increases at the level of the pelvis when walking on an insidious surface (i.e., more difficult) compared to smooth conditions, but not at the head [2124]. Normalization procedures have also been developed for RMS data to reliably compare the quality and variability of real-world gait between different populations (healthy young vs. elderly vs. neurologically impaired) and at different gait speeds [22252627].

Whilst RMS has been correlated with age or level/type of neurological impairments, there have been no models of how neural activation can predict gait stability [20]. We hypothesised that in healthy young subjects, neural activity in the PFC and PPC regions would predict gait stability, specifically measured with the acceleration RMS index. To test our hypothesis, we investigated the relationships between neural activity and RMS index during different ambulatory conditions outside the laboratory using real life tasks. We studied three common ambulatory tasks, namely self-paced free walking, walking whilst conversing and walking whilst texting on a smartphone in order to better understand the neural correlates underlying human natural behaviours.[…]

 

Continue —> Neural predictors of gait stability when walking freely in the real-world | Journal of NeuroEngineering and Rehabilitation | Full Text

 

Fig. 1 Mobile Setup for real-world experiments. Brain activity was recorded by a 64 channel EEG Waveguard cap connected to the EEGoPro amplifier placed into a backpack together with a tablet on which the recording software ran. Contact Switches were placed underneath the subject’s heels and connected to a digital input of the MWX8 DataLog analog-to-digital converter fixed at the subject’s hips by an elastic belt. Elastic bands were also placed around the subject’s thighs to make sure cables did not disturb gait performance. A digital button was connected to the converter and pressed by the subject at specific time points. A Samsung Galaxy S4 mini was firmly placed at the subject’s lower back with the elastic belt. Author S.P. gave written informed consent for the usage of this picture

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[WEB SITE] How much of our brain do we actually use? Brain facts and myths

The brain is the most complex organ in the human body. Many believe that a person only ever uses 10 percent of their brain. Is there any truth to this?

A person’s brain determines how they experience the world around them. The brain weighs about 3 pounds and contains around 100 billion neurons — cells that carry information.

In this article, we explore how much of the brain a person uses. We also bust some widely held myths and reveal some interesting facts about the brain.

How much of our brain do we use?

How much of the brain is used represented by digital render of brain activity.

Studies have debunked the myth that humans use only 10 percent of their brain.

 According to a survey from 2013, around 65 percent of Americans believe that we only use 10 percent of our brain.

But this is just a myth, according to an interview with neurologist Barry Gordon in Scientific American. He explained that the majority of the brain is almost always active.

The 10 percent myth was also debunked in a study published in Frontiers in Human Neuroscience.

One common brain imaging technique, called functional magnetic resonance imaging (fMRI), can measure activity in the brain while a person is performing different tasks.

Using this and similar methods, researchers show that most of our brain is in use most of the time, even when a person is performing a very simple action.

A lot of the brain is even active when a person is resting or sleeping.

The percentage of the brain in use at any given time varies from person to person. It also depends on what a person is doing or thinking about.

Where does the 10 percent myth come from?

It’s not clear how this myth began, but there are several possible sources.

In an article published in a 1907 edition of the journal Science, psychologist and author William James argued that humans only use part of their mental resources. However, he did not specify a percentage.

The figure was referenced in Dale Carnegie’s 1936 book How to Win Friends and Influence People. The myth was described as something the author’s college professor used to say.

There is also a belief among scientists that neurons make up around 10 percent of the brain’s cells. This may have contributed to the 10 percent myth.

The myth has been repeated in articles, TV programs, and films, which helps to explain why it is so widely believed.

Improving brain function

Like any other organ, the brain is affected by a person’s lifestyle, diet, and the amount that they exercise.

To improve the health and function of the brain, a person can do the following things.

Eat a balanced diet

Walnuts, almonds, and pecans piled up.

Nuts are high in omega fatty acids and antioxidants, making them beneficial to brain health.

Eating well improves overall health and well-being. It also reduces the risk of developing health issues that may lead to dementia, including:
  • cardiovascular disease
  • midlife obesity
  • type 2 diabetes

The following foods promote brain health:

  • Fruits and vegetables with dark skins. Some are rich in vitamin E, such as spinach, broccoli, and blueberries. Others are rich in beta carotene, including red peppers and sweet potatoes. Vitamin E and beta carotene promote brain health.
  • Oily fish. These types of fish, such as salmon, mackerel, and tuna, are rich in omega-3 fatty acids, which may support cognitive function.
  • Walnuts and pecans. They are rich in antioxidants, which promote brain health.

Exercise regularly

Regular exercise also reduces the risk of health problems that may lead to dementia.

Cardiovascular activities, such as walking briskly for 30 minutes a day, can be enough to reduce the risk of brain function declining.

Other accessible and inexpensive options include:

  • bike riding
  • jogging
  • swimming

Keep the brain active

The more a person uses their brain, the better their mental functions become. For this reason, brain training exercises are a good way to maintain overall brain health.

A recent study conducted over 10 years found that people who used brain training exercises reduced the risk of dementia by 29 percent.

The most effective training focused on increasing the brain’s speed and ability to process complex information quickly.

Other brain myths

There are a number of other popular myths about the brain. These are discussed and dispelled below.

Left-brained vs. right-brained

Two sides of the brain, left and ride shown by model of human brain divided into two hemispheres.

Research suggests that a person will not be dominated by either the left hemisphere or right, but that both sides of the brain are used equally.

Many believe that a person is either left-brained or right-brained, with right-brained people being more creative, and left-brained people more logical.

However, research suggests that this is a myth — people are not dominated by one brain hemisphere or the other. A healthy person is constantly using both hemispheres.

It is true that the hemispheres have different tasks. For instance, a study in PLOS Biologydiscussed the extent to which the left hemisphere is involved in processing language, and the right in processing emotions.

Alcohol and the brain

Long-term alcoholism can lead to a number of health problems, including brain damage.

It is not, however, as simple as saying that drinking alcohol kills brain cells — this is a myth. The reasons for this are complicated.

If a woman drinks too much alcohol while pregnant, it can affect the brain development of the fetus, and even cause fetal alcohol syndrome.

The brains of babies with this condition may be smaller and often contain fewer brain cells. This may lead to difficulties with learning and behavior.

Subliminal messages

Research suggests that subliminal messages can provoke an emotional response in people unaware that they had received emotional stimulus. But can subliminal messages help a person to learn new things?

study published in Nature Communications found that hearing recordings of vocabulary when sleeping could improve a person’s ability to remember the words. This was only the case in people who had already studied the vocabulary.

Researchers noted that hearing information while asleep cannot help a person to learn new things. It may only improve recall of information learned earlier, while awake.

Brain wrinkles

The human brain is covered in folds, commonly known as wrinkles. The dip in each fold is called the sulcus, and the raised part is called the gyrus.

Some people believe that a new wrinkle is formed every time a person learns something. This is not the case.

The brain starts to develop wrinkles before a person is born, and this process continues throughout childhood.

The brain is constantly making new connections and breaking old ones, even in adulthood.

Brain facts

Now that we have dispelled some commonly held myths, here are some facts about the brain.

Energy use

The brain represents around 2 percent of a person’s weight but uses 20 percent of their oxygen and calories.

Hydration

First established in 1945, scientists estimate that the brain is around 73 percent water.

Keeping the brain hydrated is important. Being dehydrated by as little as 2 percent may impair a person’s ability to perform tasks that involve attention, memory, and motor skills.

Cholesterol

Cholesterol is a type of fat that people often consider bad for their health.

It’s true that eating too much cholesterol is bad for the heart. However, many people are unaware that cholesterol plays a significant role in a person’s brain.

Without cholesterol, the cells in the brain would not survive.

Around 25 percent of the body’s cholesterol is contained within the brain cells.

Takeaway

Because of the organ’s complexity, scientists are still learning about the brain.

The notion that a person uses only 10 percent of their brain is a myth. fMRI scans show that even simple activities require almost all of the brain to be active.

While there is still a lot to learn about the brain, researchers continue to fill in the gaps between fact and fiction.

via How much of our brain do we actually use? Brain facts and myths

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[WEB SITE] Stress Reduction May Help Reduce Epileptic Seizures

Last Updated: February 14, 2018.

Both focused attention and progressive muscle relaxation result in reductions in seizure frequency in patients with epilepsy, according to a study published online Feb. 14 in Neurology.

Sheryl R. Haut, M.D., from the Montefiore Medical Center in Bronx, N.Y., and colleagues randomized 66 adults with medication-resistant focal epilepsy to 12 weeks of either PMR with diaphragmatic breathing or control focused-attention activity with extremity movements.

The researchers found that seizure frequency was reduced from baseline in both treatment groups (PMR: 29 percent; P < 0.05; focused attention: 25 percent; P < 0.05). There was no difference between the two interventions in seizure reduction (P = 0.38), although PMR was associated with greater stress reduction compared to focused attention (P < 0.05). Daily stress was not found to predict seizures.

“These findings highlight the need for larger, individually targeted behavioral therapy trials to control seizures and improve quality of life in patients with epilepsy,” the authors write.

Abstract/Full Text (subscription or payment may be required)

via Stress Reduction May Help Reduce Epileptic Seizures –Doctors Lounge

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[Abstract+References] Diagnostic challenges in epilepsy: seizure under-reporting and seizure detection

Summary

Epileptic seizures vary greatly in clinical phenomenology and can markedly affect the patient’s quality of life. As therapeutic interventions focus on reduction or elimination of seizures, the accurate documentation of seizure occurrence is essential. However, patient self-evaluation compared with objective evaluation by video-electroencephalography (EEG) monitoring or long-term ambulatory EEG revealed that patients document fewer than 50% of their seizures, on average, and that documentation accuracy varies significantly over time. For good clinical practice in epilepsy, novel and feasible seizure detection techniques for ambulatory long-term use are needed. Generalised tonic-clonic seizures can already be detected reliably by methods that rely on motion recording (eg, surface electromyography). However, the automatic detection of other seizure types, such as complex partial seizures, will require multimodal approaches that combine the measurement of ictal autonomic alterations (eg, heart rate) and of characteristic movement patterns (eg, accelerometry). Innovative and feasible tools for automatic seizure detection are likely to advance both monitoring of the outcome of a treatment in a patient and clinical research in epilepsy.

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via Diagnostic challenges in epilepsy: seizure under-reporting and seizure detection

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[WEB SITE] Moms-to-be, take note. European experts advise against epilepsy drug in pregnancy

The compound, valproate, is also used for migraine and bipolar disorder, and doctors already advised against prescribing the medicine for pregnant women in France.

Updated: Feb 10, 2018 13:45 IST

Valproate medicines are licenced under different names by national drugs authorities.

Valproate medicines are licenced under different names by national drugs authorities.(Shutterstock)

An expert committee of Europe’s medicines watchdog recommended Friday that a drug used to treat epilepsy and linked to malformations in children not be used in pregnancy. The compound, valproate, is also used for migraine and bipolar disorder, and doctors already advised against prescribing the medicine for pregnant women in France. France’s medicines regulator, known by the acronym ANSM, asked the London-based European Medicines Agency (EMA) to conduct a risk review.

The EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) said in a statement Friday it was recommending that valproate not be used by pregnant women for any of the three medical conditions. For women suffering from epilepsy, however, it may be impossible for some to stop after becoming pregnant, it said. These may have to continue treatment, though with “appropriate specialist care”. The experts also advised against prescribing the drug for women “from the time they become able to have children”, unless using contraception.

Valproate medicines are licenced under different names by national drugs authorities. The committee recommendations will now go to another body of the EMA, which deals with concerns over drugs that are not centrally authorised in the EU. Last April, a preliminary study showed that valproate caused “severe malformations” in as many as 4,100 children in France since the drug was first marketed in the country in 1967.
Women who took the drug during pregnancy to treat epilepsy were four times more likely to give birth to babies with congenital malformations, said a report of the French National Agency for the Safety of Medicines (ANSM) and the national health insurance administration. Birth defects included spina bifida — a condition in which the spinal cord does not form properly and can protrude through the skin — as well as defects of the heart and genital organs. The risk of autism and developmental problems was also found to be higher.
via Moms-to-be, take note. European experts advise against epilepsy drug in pregnancy | fitness | Hindustan Times

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[Abstract] Validity of Robot-Based Assessments of Upper Extremity Function

Abstract

Objective

To examine the validity of 5 robot-based assessments of arm motor function poststroke.

Design

Cross-sectional study.

Setting

Outpatient clinical research center.

Participants

Volunteer sample of participants (N=40; age, >18y; 3–6mo poststroke) with arm motor deficits that had reached a stable plateau.

Interventions

Not applicable.

Main Outcome Measures

Clinical standards included the arm motor domain of the Fugl-Meyer Assessment (FMA) and 5 secondary motor outcomes: hand/wrist subsection of the arm motor domain of the FMA, Action Research Arm Test, Box and Block test (BBT), hand motor subscale of the Stroke Impact Scale Version 2.0, and Barthel Index. Robot-based assessments included wrist targeting, finger targeting, finger movement speed, reaction time, and a robotic version of the BBT. Anatomical measures included percent injury to the corticospinal tract (CST) and extent of injury of the hand region of the primary motor cortex obtained from magnetic resonance imaging.

Results

Participants had moderate to severe impairment (arm motor domain of the FMA scores, 35.6±14.4; range, 13.5–60). Performance on the robot-based tests, including speed (r=.82; P<.0001), wrist targeting (r=.72; P<.0001), and finger targeting (r=.67; P<.0001), correlated significantly with the arm motor domain of the FMA scores. Wrist targeting (r=.57–.82) and finger targeting (r=.49–.68) correlated significantly with all 5 secondary motor outcomes and with percent CST injury. The robotic version of the BBT correlated significantly with the clinical BBT but was less prone to floor effects. Robot-based assessments were comparable to the arm motor domain of the FMA score in relation to percent CST injury and superior in relation to extent of injury to the hand region of the primary motor cortex.

Conclusions

The present findings support using a battery of robot-based methods for assessing the upper extremity motor function in participants with chronic stroke.

via Validity of Robot-Based Assessments of Upper Extremity Function – Archives of Physical Medicine and Rehabilitation

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[BLOG POST] Traumatic Brain Injury- Virtual Reality Technology Used For Vision Therapy

February 12, 2018

So, here is a new subject that hints at hope for traumatic brain injury (TBI) patients. I have previously discussed the role of vision therapy in helping head injury patients, especially those who are having difficulty reading.
Vision therapy is a set of vision exercises and training performed by optometrists with unique equipment in their offices.

Vision therapy certainly has a role in rehabilitation but has numerous obstacles. Number one- patients must make regular appointments for a doctor’s office visit often located some distance from home. Two, only a few optometrist’s perform vision therapy. And third, the cost of therapy is usually not covered by medical insurance.

The future may lie in VIRTUAL REALITY– futuristic-looking goggles and head sets that allow individuals to play 3-D computer games in an immersive environment. The technology keeps improving and costs are coming down.

Forward-looking technology companies are also developing programs for traumatic brain injury (TBI) patients. Only early versions are currently available but the possibility of at-home rehabilitation will soon become a medical reality. All of medicine is moving in this direction.

Reading, depth perception, contrast sensitivity, and peripheral vision disorders can all be explored in virtual reality. The brain and the eye will truly come together in a revolution of new products to aid patients with ocular disease. There are already devices to help people who are blind, but the cost of such devices is considerable. The cost of virtual reality computer goggles and headsets will be coming down in price to sell to the general public- the same techniques that are being explored to develop entertainment are being developed by health companies to treat patients.

In the next year or two, the market will present these devices and an at-home device and therapy to treat TBI victims will be available. In my blog I have explained the many ways head injury can effect eyesight, but there are almost no cures. Cures may be a long way off, but programs to help people read again, reduce double vision, and regain their ability to judge depth are already in the pipeline. I’m not currently an investor in any device, and I will not discuss specific companies, but the research and data is on the internet.

Also, there are already programs you can get on a regular computer screen for vision training and I will discuss these in future blogs. Again, ophthalmologists interested in TBI and related visual disorders can be at a frontier of a whole new branch of ophthalmology. I examine and evaluate TBI patients in my practice everyday and I will keep those who read my blog posted on new information.

Stay tuned!

Steven H. Rauchman, M.D. is an eye physician and surgeon who has been in private practice for 30 years. He has served as an Traumatic Brain Injury (TBI) medical/legal expert for the last 6 years specializing in the area of personal injury and related traumatic brain injuries.

 

via Traumatic Brain Injury- Virtual Reality Technology Used For Vision Therapy

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[WEB SITE] Local rehabilitation center uses virtual reality to help patients

SPOKANE, Wash. — Virtual reality technology makes it possible to visit a new world, or test drive a new ride from the comfort of your home. But it offers more than just a good time.

Saint Luke’s Rehabilitation Institute is using our region’s first ever virtual reality driving simulator to provide patients with rehab exercises.

“There’s a lot of anxiety of even though they’ve been told by a therapist that they can drive, or that they might be ok to drive, they still have that question of ‘am I ready’ or ‘is this safe?'” St. Luke’s Occupational Therapist Devin Hatch said. “This allows them to get more comfortable.”

Hatch said their virtual reality simulator helps patients who have suffered a stroke, spinal cord or brain injury re-learn safe driving skills before trying it out in reality.

“There was no real good bridge between actual driving and in-clinic stuff,” Hatch said. “So this has given us the bridge to cover the gap of what we do in the clinic and actual on the road driving.”

The VR driving simulator allows Hatch to assess his patient’s brain injury with steering and braking, and how they manage typical distractions they would experience on the road. Scenarios range from city driving to country roads.

“It’s nice to see what people are coming up with and how we can apply that to a health care setting to let people practice things without putting anyone at danger,” Hatch said.

© 2018 KREM-TV

via Local rehabilitation center uses virtual reality to help patients | KREM.com

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[ARTICLE] Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last? – Full Text PDF

The interest in cannabis-based products for the treatment of refractory epilepsy has skyrocketed in recent years. Marijuana and other cannabis products with high content in Δ(9) –tetrahydrocannabinol (THC), utilized primarily for recreational purposes, are generally unsuitable for this indication, primarily because THC is associated with many undesired effects. Compared with THC, cannabidiol (CBD) shows a better defined anticonvulsant profile in animal models and is largely devoid of adverse psychoactive effects and abuse liability. Over the years, this has led to an increasing use of CBD-enriched extracts in seizure disorders, particularly in children. Although improvement in seizure control and other benefits on sleep and behavior have been often reported, interpretation of the data is made difficult by the uncontrolled nature of these observations. Evidence concerning the potential anti-seizure efficacy of cannabinoids reached a turning point in the last 12 months, with the completion of three high-quality placebo-controlled adjunctive-therapy trials of a purified CBD product in patients with Dravet syndrome and Lennox-Gastaut syndrome. In these studies, CBD was found to be superior to placebo in reducing the frequency of convulsive (tonic-clonic, tonic, clonic, and atonic) seizures in patients with Dravet syndrome, and the frequency of drop seizures in patients with Lennox-Gastaut syndrome. For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes. Based on currently available information, however, it is unclear whether the improved seizure control described in these trials was related to a direct action of CBD, or was mediated by drug interactions with concomitant medications, particularly a marked increased in plasma levels of N-desmethylclobazam, the active metabolite of clobazam. Clarification of the relative contribution of CBD to improved seizure outcome requires re-assessment of trial data for the subgroup of patients not comedicated with clobazam, or the conduction of further studies controlling for the confounding effect of this interaction. (2017;7:61-76) […]

Full Text PDF 

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